Heart disease to cost U.S. $503 billion in 2010

Heart group says many cases could have been prevented.

A U.S. heart patient is prepared for a two-hour surgery at Bangkok Heart Hospital in Bangkok.

WASHINGTON - Cardiovascular disease and stroke will cost the United States an estimated $503.2 billion in 2010, an increase of nearly 6 percent, and many cases could have been prevented, the American Heart Association said on Thursday.

The figure includes both health care costs and lost productivity due to death and disease, according to an update published online in the journal Circulation.

The heart association says obesity and other risk factors, like too little exercise and poor diet, are fueling the expected increase in health care costs associated with heart disease and stroke.

"Current statistical data show Americans to be on average overweight, physically inactive and eating a diet that is too high in calories, sodium, fat and sugar," said Dr. Donald Lloyd-Jones, head of the American Heart Association Statistics Committee.

Lloyd-Jones, a cardiologist at Northwestern University in Chicago, said too many people do not take cholesterol-lowering medicines that could lower their risk.

"One reason it will cost us more to treat tomorrow's patients is because there will be more of them if current trends continue," Lloyd-Jones said in a statement.

According to the heart association, 59 percent of adults who responded to a 2008 national survey described themselves as physically inactive.

The report also says fewer than half of people with heart disease symptoms are receiving cholesterol-lowering drugs, like statins.

Heart disease is the No. 1 killer of men and women in the United States and in most industrialized countries. According to the World Health Organization, cardiovascular diseases and diabetes accounted for 32 percent of all deaths globally in 2005.

The heart association said the number of inpatient cardiovascular operations and procedures jumped 33 percent from 1996 to 2006, from 5.4 million to 7.2 million.

By 2020, the American Heart Association hopes to reduce U.S. deaths from cardiovascular diseases and stroke by 20 percent.

"To reach the 2020 goals, Americans must start making healthier lifestyle choices," Lloyd-Jones said.

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Danger at home: Rare form of TB comes to U.S.

First U.S. case of extremely drug-resistant strain of tuberculosis diagnosed 

Editor's note: Once curable diseases such as tuberculosis and malaria are rapidly mutating into aggressive strains that resist drugs. The reason: The misuse of the very drugs that were supposed to save us has built up drug resistance worldwide. First of a five-part series.

Oswaldo Juarez looks out of the window from his room at the A.G. Holley State Hospital on June 4 in Lantana, Fla. Shortly after coming to the United States to study English at age 19, Juarez was diagnosed with extremely drug-resistant tuberculosis, the first case ever seen in this country. He was treated at a sanitarium for nearly two years before being discharged.

LANTANA, Fla. - It started with a cough, an autumn hack that refused to go away.

Then came the fevers. They bathed and chilled the skinny frame of Oswaldo Juarez, a 19-year-old Peruvian visiting the United States to study English. His lungs clattered, his chest tightened and he ached with every gasp. During a wheezing fit at 4 a.m., Juarez felt a warm knot rise from his throat. He ran to the bathroom sink and spewed a mouthful of blood.

I'm dying, he told himself, "because when you cough blood, it's something really bad."

It was really bad, and not just for him.

Doctors say Juarez's incessant hack was a sign of what they have both dreaded and expected for years — this country's first case of a contagious, aggressive, especially drug-resistant form of tuberculosis. The Associated Press learned of his case, which until now has not been made public, as part of a six-month look at the soaring global challenge of drug resistance.

Juarez's strain — so-called extremely drug-resistant (XXDR) TB — has never before been seen in the U.S., according to Dr. David Ashkin, one of the nation's leading experts on tuberculosis. XXDR tuberculosis is so rare that only a handful of other people in the world are thought to have had it.

"He is really the future," Ashkin said. "This is the new class that people are not really talking too much about. These are the ones we really fear because I'm not sure how we treat them."

Forty years ago, the world thought it had conquered TB and any number of other diseases through the new wonder drugs: antibiotics. U.S. Surgeon General William H. Stewart announced it was "time to close the book on infectious diseases and declare the war against pestilence won."

Today, all the leading killer infectious diseases on the planet — TB, malaria and HIV among them — are mutating at an alarming rate, hitchhiking their way in and out of countries. The reason: overuse and misuse of the very drugs that were supposed to save us.

Just as the drugs were a manmade solution to dangerous illness, the problem with them is also manmade. It is fueled worldwide by everything from counterfeit drugmakers to the unintended consequences of giving drugs to the poor without properly monitoring their treatment. Here's what the AP found:

• In Cambodia, scientists have confirmed the emergence of a new drug-resistant form of malaria, threatening the only treatment left to fight a disease that already kills 1 million people a year.
• In Africa, new and harder to treat strains of HIV are being detected in about 5 percent of new patients. HIV drug resistance rates have shot up to as high as 30 percent worldwide.
• In the U.S., drug-resistant infections killed more than 65,000 people last year — more than prostate and breast cancer combined. More than 19,000 people died from a staph infection alone that has been eliminated in Norway, where antibiotics are stringently limited.

"Drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB and it came roaring back. We need to make sure that doesn't happen again," said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who was himself infected with tuberculosis while caring for drug-resistant patients at a New York clinic in the early '90s. "We are all connected by the air we breathe, and that is why this must be everyone's problem."

This April, the World Health Organization sounded alarms by holding its first drug-resistant TB conference in Beijing. The message was clear — the disease has already spread to all continents and is increasing rapidly. Even worse, WHO estimates only 1 percent of resistant patients received appropriate treatment last year.

"We have seen a huge upburst in resistance," said CDC epidemiologist Dr. Laurie Hicks.

Lynne Sladky / AP This photo taken July 30 shows X-rays from a tuberculosis patient at A. G. Holley State Hospital, a quarantine hospital in Lantana, Fla., that is now managing new and virulent forms of the disease.

A ‘time bomb’
Juarez' strain of TB puzzled doctors. He had never had TB before. Where did he pick it up? Had he passed it on? And could they stop it before it killed him?

At first, mainstream doctors tried to treat him. But the disease had already gnawed a golf-ball-sized hole into his right lung.

TB germs can float in the air for hours, especially in tight places with little sunlight or fresh air. So every time Juarez coughed, sneezed, laughed or talked, he could spread the deadly germs to others.

"You feel like you're killing somebody, like you could kill a lot of people. That was the worst part," he said.

Tuberculosis is the top single infectious killer of adults worldwide, and it lies dormant in one in three people, according to WHO. Of those, 10 percent will develop active TB, and about 2 million people a year will die from it.

Simple TB is simple to treat — as cheap as a $10 course of medication for six to nine months. But if treatment is stopped short, the bacteria fight back and mutate into a tougher strain. It can cost $100,000 a year or more to cure drug-resistant TB, which is described as multi-drug-resistant (MDR), extensively drug-resistant (XDR) and XXDR.

There are now about 500,000 cases of MDR tuberculosis a year worldwide. XDR tuberculosis killed 52 of the first 53 people diagnosed with it in South Africa three years ago.

Drug-resistant TB is a "time bomb," said Dr. Masae Kawamura, who heads the Francis J. Curry National Tuberculosis Center in San Francisco, "a manmade problem that is costly, deadly, debilitating, and the biggest threat to our current TB control strategies."

Juarez underwent three months of futile treatment in a Fort Lauderdale hospital. Then in December 2007 he was sent to A.G. Holley State Hospital, a 60-year-old massive building of brown concrete surrounded by a chain-link fence, just south of West Palm Beach.

"They told me my treatment was going to be two years, and I have only one chance at life," Juarez said. "They told me if I went to Peru, I'm probably going to live one month and then I'm going to die."

Holley is the nation's last-standing TB sanitarium, a quarantine hospital that is now managing new and virulent forms of the disease.

Tuberculosis has been detected in the spine of a 4,400-year-old Egyptian mummy. In the 1600s, it was known as the great white plague because it turned patients pale. In later centuries, as it ate through bodies, they called it "consumption." By 1850, an estimated 25 percent of Europeans and Americans were dying of tuberculosis, often in isolated sanatoriums like Holley where they were sent for rest and nutrition.

Then in 1944 a critically ill TB patient was given a new miracle antibiotic and immediately recovered. New drugs quickly followed. They worked so well that by the 1970s in the U.S., it was assumed the disease was a problem of the past.

Once public health officials decided TB was gone, the disease was increasingly missed or misdiagnosed. And without public funding, it made a comeback among the poor. Then immigration and travel flourished, breaking down invisible walls that had contained TB.

Drug resistance emerged worldwide. Doctors treated TB with the wrong drug combinations. Clinics ran out of drug stocks. And patients cut their treatment short when they felt better, or even shared pills with other family members.

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There are two ways to get drug-resistant TB. Most cases develop from taking medication inappropriately. But it can also be transmitted like simple TB, a cough or a sneeze.

In the 1980s, HIV and AIDS brought an even bigger resurgence of TB cases. TB remains the biggest killer of HIV patients today.

For decades, drug makers failed to develop new medicines for TB because the profits weren't there. With the emergence of resistant TB, several private drug companies have started developing new treatments, but getting an entire regimen on the market could take 24 years. In the meantime, WHO estimates each victim will infect an average of 10 to 15 others annually before they die.

 

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HIV infections and deaths fall as drugs have impact

Sub-Saharan Africa has by far the highest rate of HIV infecti

Greater access to anti-retroviral drugs has helped cut the death toll from HIV by more than 10% over the past five years, latest figures show.

The World Health Organization and the Joint UN Programme on HIV/Aids (UNAids) say an estimated 33.4 million people worldwide are infected with HIV.
That figure is up from 33 million in 2007 because fewer are dying with HIV.
The latest report also shows there has been a significant drop in the number of new HIV infections.

TOTAL INFECTIONS 2008 Sub-Saharan Africa: 22.4 m South and South-east Asia: 3.8m East Asia: 850,000 Latin America: 2.0m North America: 1.4m Western and Central Europe: 850,000 Eastern Europe and Central Asia: 1.5m Caribbean: 240,000 Middle East and North Africa: 310,000 Oceania: 59,000

UNAids and WHO say better access to powerful drug treatments has helped save many lives.
The report estimates that since the availability of effective treatment in 1996, some 2.9 million lives have been saved.
In total, almost 60 million people have been infected by HIV and 25 million people killed by causes related to the virus since the epidemic started.
Prevention programmes
The report also suggests that HIV prevention programmes have had a significant impact.

NEW INFECTIONS 2008 Sub-Saharan Africa: 1.9m South and South-east Asia: 280,000 East Asia: 75,000 Latin America: 170,000 North America: 55,000 Western and Central Europe: 30,000 Eastern Europe and Central Asia: 110,000 Caribbean: 20,000 Middle East and North Africa: 35,000 Oceania: 3,900

It says new HIV infections have been reduced by 17% over the past eight years.
In sub-Saharan Africa, the epicentre of the global pandemic, the number of new infections has fallen by around 15% since 2001 - equating to about 400,000 fewer infections in 2008 alone.
In the same period, infection rates were down by nearly 25% in East Asia, and by 10% in South and South East Asia.
In Eastern Europe, after a dramatic increase in new infections among injecting drug users, the rate of infection has levelled off considerably.
Director general of the World Health Organization Dr Margaret Chan said: "International and national investment in HIV treatment scale-up has yielded concrete and measurable results.
"We cannot let this momentum wane. Now is the time to redouble our efforts, and save many more lives."
Child infections

AIDS DEATHS 2008 Sub-Saharan Africa: 1.4m South and South-east Asia: 270,000 East Asia: 59,000 Latin America: 77,000 North America: 25,000 Western and Central Europe: 13,000 Eastern Europe and Central Asia: 87,000 Caribbean: 12,000 Middle East and North Africa: 20,000 Oceania: 2,000

Anti-retroviral therapy has also made a significant impact in preventing new infections in children as more HIV-positive mothers gain access to treatment preventing them from transmitting the virus to their children.
Around 200,000 new infections among children have been prevented since 2001.
In Botswana, where treatment coverage is 80%, Aids-related deaths have fallen by more than 50% over the past five years and the number of children orphaned is also coming down as parents are living longer.

Michael Sidibe, Executive Director of UNAIDS:" We are seeing a decrease in mortality by 18%"

UNAids executive director Michel Sidibe said although prevention programmes had helped cut new infections, they were often "off the mark".
"If we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved," he said.

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Cup of mint tea is an effective painkiller

Graciela Rocha with one of her Brazilian mint plants

A cup of Brazilian mint tea has pain relieving qualities to match those of commercially available analgesics, a study suggests.

Hyptis crenata has been prescribed by Brazilian healers for millennia to treat ailments from headaches and stomach pain to fever and flu.
Working on mice, a Newcastle University team has proved scientifically that the ancient medicine men were right.
The study is published in the journal Acta Horticulturae.
In order to mimic the traditional treatment as closely as possible, the Newcastle team carried out a survey in Brazil to find out how the medicine is typically prepared and how much should be consumed.
The most common method was to produce a decoction. This involves boiling the dried leaves in water for 30 minutes and allowing the liquid to cool before drinking it as a tea.

The taste isn't what most people here in the UK would recognize as a mint Graciela Rocha Newcastle University

The team found that when the mint was given at a dose similar to that prescribed by traditional healers, the medicine was as effective at relieving pain as a synthetic aspirin-style drug called Indometacin.
They plan to launch clinical trials to find out how effective the mint is as a pain relief for people.
Lead researcher Graciela Rocha said: "Since humans first walked the Earth we have looked to plants to provide a cure for our ailments - in fact it is estimated more than 50,000 plants are used worldwide for medicinal purposes.
"Besides traditional use, more than half of all prescription drugs are based on a molecule that occurs naturally in a plant.
"What we have done is to take a plant that is widely used to safely treat pain and scientifically proven that it works as well as some synthetic drugs.
"Now the next step is to find out how and why the plant works."
Graciela is Brazilian and remembers being given the tea as a cure for every childhood illness.
'Interesting research'
She said: "The taste isn't what most people here in the UK would recognize as a mint.
"In fact it tastes more like sage which is another member of the mint family.
"Not that nice, really, but then medicine isn't supposed to be nice, is it?"
Dr Beverly Collett, chair of the Chronic Pain Policy Coalition, said: "Obviously further work needs to be done to identify the molecule involved, but this is interesting research into what may be a new analgesic for the future.
"The effects of aspirin-like substances have been known since the ancient Greeks recorded the use of the willow bark as a fever fighter.
"The leaves and bark of the willow tree contain a substance called salicin, a naturally occurring compound similar to acetylsalicylic acid, the chemical name for aspirin."
The research is being presented at the International Symposium on Medicinal and Nutraceutical Plants in New Delhi, India.

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Gene offers bowel cancer 'shield'

Bowel cancer is a common form of the disease

A gene known to shield the body from harmful chemicals may also protect against bowel cancer, a study suggests.

Dundee scientists found that removing a single gene from mice predisposed to cancers of the small intestine led to a 50-fold increase in tumours.
The rise in adenomas - pre-cancerous growths - appeared to be linked to increased inflammation of the bowel, the study in the journal PNAS reported.
The GSTP gene has previously been linked to a reduction in lung tumours.
Several studies have shown it appears to provide protection to both the lungs and the skin against cancerous growths. But this latest research from the University of Dundee suggests in the bowel it may work in another way.
Specifically it found that there was more inflammation in the small intenstines of mice who had the GSTP gene removed.

We are in the process of unravelling the story, and a study like this is another piece of the jigsaw Dr Rob Glynne Jones Bowel Cancer UK

Inflammation has already been associated with the risk of developing polyps - some types of which may go on to become cancerous, like adenomas - and it may be here that the gene plays a protective role.
Doctors already know of two genetic conditions which increase the risk of developing bowel cancer: FAP, or familial adenomatous polyposis, and HNPCC, which stands for hereditary non-polyposis colorectal cancer.
These conditions are however only responsible for about one in 20 cases of bowel cancer.
Inflammatory responses
The findings do not have any immediate clinical application, but experts note studies have suggested that certain types of food such as broccoli may boost GSTP levels.
"If this can be confirmed in humans, it could suggest another way of reducing the risk of bowel cancer," said Dr Lesley Walker, director of cancer information at Cancer Research UK, which funded the research.
Dr Rob Glynne Jones, chief medical adviser at Bowel Cancer UK welcomed the latest research.
He said: "We are beginning to realise that inflammatory responses are very important - both in terms of a predisposition to cancer but also how you respond to treatment.
"We are in the process of unravelling the story, and a study like this is another piece of the jigsaw. Anything we can find out about possible causes helps us at every level - and what this looks like here is another potential pathway to disease."
Professor William Steward of Beating Bowel Cancer said it was encouraging that this was a gene which could be influenced by diet.
"These findings lead to the possibility of developing approaches to preventing colorectal cancer," he said. "Given the marked rise in the number of cases of bowel cancer, in particular among young people, this research could have important implications for reducing the risk and for tackling this worrying trend."

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Cold, Flu, and Sinus

Research Yields Clues to Severe Form of Sinusitis.
U.S. researchers say they’ve identified a protein that causes nasal and sinus polyps in 15 percent to 30 percent of people with chronic sinusitis.
The condition is one of the most serious forms of sinusitis, a constant irritation and swelling of the nasal passages. Polyps — unhealthy overgrowths of sinus tissue — can block the sinus passages and make it difficult or impossible to breathe through the nose. This often leads to pain, swelling and infections.
“This type of sinusitis isn’t subtle — you can spot the patients with polyps across the room. They’re breathing through their mouths, they talk with nasal voices, they’re constantly sniffling, and their faces are swollen,” Dr. Jean Kim, an assistant professor in the departments of otolaryngology and allergy and clinical immunology at the Johns Hopkins University School of Medicine, said in a news release.
Kim and colleagues analyzed sinus tissue from patients and concluded that a protein called vascular endothelial growth factor (VEGF) — which is known to stimulate blood vessel growth — causes the cell overgrowth that causes the polyps.
The protein may offer a target for new treatments for the condition, which typically resists all current therapies. Surgery is a common treatment but the polyps nearly always regrow. Oral steroids only temporarily treat the problem and have a number of harmful side effects.
“In the future, we might have a nasal spray with an anti-VEGF agent in it,” Kim said.
The study appears in the Dec. 1 issue of the American Journal of Respiratory and Critical Care Medicine.
More information
The U.S. National Institute of Allergy and Infectious Diseases has more about sinusitis.
— Robert Preidt
SOURCE: Johns Hopkins Medicine, news release, Nov. 23, 2009
Last Updated: Nov. 23, 2009

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Breast Cancer

Recent Cancer Screening Changes Leave Many Confused.

The world of cancer screening has been upended in the past two weeks. Not only did the U.S. Preventive Services Task Force (USPSTF) just raise the age at which it recommends women get their first mammogram from 40 to 50, but the American College of Obstetrics and Gynecologists (ACOG) decided that adolescents should be spared the inconvenience and possible risks of cervical cancer screening, and wait until they reach the age of 21 for such testing. Both groups also recommended screening less frequently.

Add to that the long-simmering debate on the value of PSA testing for prostate cancer and the fact that both the American Cancer Society (ACS) and the American College of Radiology have condemned the new USPSTF recommendations, it’s no wonder patients and even experts feel like they are suffering from a bad case of medical whiplash.
Was the timing of the announcements anything more than coincidence? Are the changes a reflection of new science, attempts to influence the current raging health-care debate or just medical business as usual?
The timing, by most accounts, was purely accidental.
“I think it’s a coincidence that this [the mammogram recommendation] came out when it did, right in the middle of the health-care reform discussion. It’s a good panel, one that was dedicated to getting the right answer to what should be done about this,” said Dr. Robert J. Barnet, senior scholar in residence at the Center for Clinical Bioethics at Georgetown University, in Washington, D.C.
Added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La: “This is nothing new. Cancer screening guidelines have been changing as more scientific knowledge accumulates.”
And much of the new knowledge does suggest that over-screening does happen, often resulting in false-positive results, which lead to more biopsies and more angst. This is true of breast, cervical, prostate and other forms of cancer, experts concur.
“There’s appropriate screening and there is the appropriate population that should be getting that screening, and there is the appropriate screening interval,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “We can violate all of those things.”
Meanwhile, false-positive results from mammographies are more common in younger (age 40 to 49) women than in the upper age bracket. And the age cut-offs for screening may be artificial.
“We like to lump people into big decades of life, so the risk of a 40-year-old woman and the risk of a 49-year-old woman [for breast cancer] are different,” Brooks noted. “The risk at 40 is much less than the risk at 49.”
“Younger women are at higher rates of false-positives, which results in more biopsies, more procedures being done and women getting callbacks for extra mammograms,” he added. “This creates anxiety for something that’s not anything bad.”
Also, there’s increasing evidence that some cancers will never turn into anything dangerous and, therefore, don’t warrant treatment.
“Our definition of cancer was given to us by German pathologists in the 1840s after they looked at biopsies from autopsy specimens,” Brawley explained. “Now, 170 years later, we’ve progressed in terms of imaging, in terms of medical diagnostics into what I call the genetic and molecular biologic age, but our ability to define cancer has not progressed beyond the light microscope. What we need to be able to do eventually is say that ‘this cancer is never going to progress,’ it is not going to spread and invade other organs in the body. But right now we don’t have the molecular tools to predict their behavior.”
“Not only do we need to find small tumors, we need to know more about the biology of those tumors,” added Dr. Michael V. Seiden, president and CEO of Fox Chase Cancer Center in Philadelphia.
Until those tools are developed, imperfect screening is going to lead to over-diagnosis and unnecessary treatment.
Still, there’s no question that the revisions do fit into a larger and rapidly changing health-care picture.
“Where I think the question was solely focused on ‘can you prevent cancer death?’ … 10 years ago or 20 years ago, I think there has been a much more open dialogue about the burden of screening, the cost burden, the anxiety burden, the false-positive burden,” Seiden said. “As screening techniques become more sensitive, you do a better and better job of capturing people with cancer but you also do a better job of capturing people with tumors they might not have died from. So, all of a sudden the incidence of pre-malignant breast disease, the incidence of low-grade prostate cancer, starts doubling and the death rate drops, but only very, very modestly.”
While the USPSTF stated that cost considerations had nothing to do with the new breast cancer recommendations announcement, ACOG did mention costs in its announcement regarding changes to cervical cancer screening.
“In this country, health care is an enormous issue and it is the single greatest driver of the national debt,” Brooks said. “There’s nothing wrong with raising financial questions in a public health setting.”
“It’s my belief that the task force just set the date [for its announcement] and wasn’t really paying attention to the politics. In truth, I don’t know but . . . part of the way of controlling costs is the rational use of medical care, not the rationing of care,” Brawley said. “For most women in the U.S., to get a Pap smear on an annual basis means that we’re going to spend three times more on cervical cancer screening than we need to spend and we’ve actually gotten evidence that screening tests every five years is going to save as many women as every three years [but] we’ve gone every three years to be safer.”
According to Brawley, ACOG’s new cervical cancer guidelines “look amazingly” like the 2002 American Cancer Society guidelines.
The ACS does not agree with the new USPSTF guidelines for breast cancer screening, however.
“Our view is that breast cancer screening saves lives and women aged 40 and above should get a high quality mammogram and clinical breast exam on an annual basis,” Brawley said.
Ochsner Health System’s Brooks is not changing his advice to women. “I tell women at age 40, if she wants to begin screening with mammography, it’s fine,” he said. “I haven’t changed what I’m recommending in my practice but I try to explain to women what the rationale behind it is.”
More information
To see the new breast cancer screening recommendations, visit the U.S. Preventive Services Task Force.
By Amanda Gardner
HealthDay Reporter

SOURCES: Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Health System, Baton Rouge, La.; Robert J. Barnet, M.D., senior scholar in residence, Center for Clinical Bioethics, Georgetown University, Washington, D.C.; Otis Brawley, M.D., chief medical officer, American Cancer Society; Michael V. Seiden, M.D., Ph.D., president and CEO, Fox Chase Cancer Center, Philadelphia
Last Updated: Nov. 24, 2009

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Health News: Asthma

Traffic, Dust Linked to Asthma in Kids

 Infants exposed to outdoor traffic pollution and indoor endotoxin are at increased risk for asthma, researchers say.
Endotoxin — a component of bacteria believed to trigger an immune response in humans — is found in dust.
University of Cincinnati College of Medicine researchers found persistent wheezing (an early warning sign of asthma and other lung conditions) in 36 percent of 3-year-olds who were exposed to high levels of traffic pollution and indoor endotoxin as infants.
In comparison, wheezing was seen in 11 percent of children exposed to low levels of outdoor and indoor allergens as infants, and in 18 percent of children exposed to high levels of traffic pollution and low levels of indoor endotoxin. Endotoxin exposure alone appeared to have little effect on children, the study authors noted.
“There is a clear synergistic effect from co-exposure to traffic-related particles and endotoxin above and beyond what you would see with a single exposure that can be connected to persistent wheezing by age 3,” study author Patrick Ryan, a research assistant professor of environmental health, said in a university news release. “These two exposure sources — when simultaneously present at high levels — appear to work together to negatively impact the health of young children with developing lungs.”
“Traffic-related particles and endotoxin both seem to trigger an inflammatory response in the children monitored in this study. When put together, that effect is amplified to have a greater impact on the body’s response,” Ryan explained. “The earlier in life this type of exposure occurs, the more impact it may have long term. Lung development occurs in children up through age 18 or 20. Exposure earlier in life to both endotoxin and traffic will have a greater impact on developing lungs compared to adults whose lungs are already developed.”
The findings are published in the Dec. 1 issue of the American Journal of Respiratory and Critical Care Medicine.

More information
The American Academy of Allergy, Asthma and Immunology offers tips for the prevention of allergies and asthma in children.
— Robert Preidt
SOURCE: University of Cincinnati Academic Health Center, news release, Nov. 24, 2009
Last Updated: Nov. 24, 2009

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Heart Disease

Angioplasty Outcomes May Vary Little Between Hospitals. 

Do hospitals that conduct the most angioplasties necessarily produce the best results for patients? Maybe not.

Prior research had suggested that “practice makes perfect” when it comes to artery-opening procedures, but a new study involving over 30,000 patients finds low- and high-volume hospitals performing more or less equally.
The study included patients with what are called primary angioplasties, cared for at 166 hospitals across the United States between 2001 and 2007.
The researchers found no significant difference in outcome between medical centers that did high volumes of such procedures and those that didn’t do all that many.
“The message here is that volume alone is not a sufficient target marker for outcome,” said study senior author Dr. Deepak Bhatt, chief of cardiology at the VA Boston Healthcare System and associate professor of medicine at Harvard Medical School. His team reported the findings in the Nov. 25 issue of the Journal of the American Medical Association.
Studies done several years ago did find better results at high-volume hospitals, “but I think things have changed,” Bhatt said. “Devices and techniques, and overall results have improved.”
Hospitals were classified in three groups: low-volume, with fewer than 36 primary angioplasties a year; middle-volume, between 36 and 70 procedures; and high-volume, with 70 or more procedures a year.
The in-hospital death rate was 3 percent for high-volume hospitals, 3.2 percent for medium-volume hospitals and 3.9 percent for low-volume hospitals, a difference that is not statistically significant, the report said.
The length of hospital stays was virtually the same for all hospitals: 4.6 days for low-volume, 4.5 days for medium-volume, 4.7 days for high-volume. But there was a difference in the interval between arrival at the hospital and beginning of angioplasty: 98 minutes for low-volume hospitals, 90 minutes for medium-volume and 88 minutes for high-volume. And high-volume hospitals were more likely to fulfill the guideline recommending start of an angioplasty within 90 minutes of arrival at a hospital.
Overall, the new findings are “really good news for patients in general, because it means that whatever hospital you go to, the result is likely to be good,” said Dr. Issam D. Moussa, associate professor of medicine and director of the endovascular service at Weill Medical College of Cornell University, New York City, and a spokesman for the Society for Cardiovascular Angiography and Interventions.
The study results also confirm current guidelines about emergency treatment for heart attacks, Moussa said. “When they pick you up, they should take you to the nearest hospital,” he said. “This study doesn’t change that.”
But he also said the findings of the study were not unshakable because of the relatively small number of people treated in low-volume hospitals.
“Low-volume hospitals [in the study] included only 3,000 patients,” Moussa said. “Because of that low number, the results cannot be conclusive.”
The difference between in-hospital death rates found in the study might have been statistically significant had the numbers been higher, he said. And the study also excluded about 120 hospitals because they reported too few primary angioplasties, Moussa said.
The study also looked only at in-hospital deaths, Bhatt noted. “If we looked at longer-term outcomes, differences might emerge,” he said.
Still, the study casts some doubt on the notion that in cardiology, practice makes perfect, Bhatt noted. “Within the range we studied and the kinds of hospitals we studied, the difference was not there,” he said.
In a related study published in the same issue of the journal, Norwegian researchers say that giving out-of-hospital cardiac arrest patients intravenous epinephrine therapy does not boost long-term survival.
A team from Oslo University compared outcomes for over 850 patients experiencing out-of-hospital cardiac arrest. Half received standard IV epinephrine as part of advanced cardiac life support, while the other half did not. The team found that about 10 percent of patients survived to hospital discharge, whether or not they had received the IV treatment.
More information
Emergency treatments for heart attacks are described by the U.S. National Heart, Lung and Blood Institute.
By Ed Edelson
HealthDay Reporter
SOURCES: Deepak Bhatt, M.D., chief, cardiology, VA Boston Healthcare System, associate professor, medicine, Harvard Medical School, Boston; Issam D. Moussa, M.D., associate professor, medicine, director, endovascular service, Weill Medical College of Cornell University, New York City; Nov. 25, 2009, Journal of the American Medical Association
Last Updated: Nov. 24, 2009

 

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Smokers Double Their Risk for Heart Disease

A new study offers yet more proof that smoking is a major risk factor for death from heart disease and cancer. Researchers followed 12,152 American and European male and female smokers, formers smokers and nonsmokers for three years. During that time, current smokers were 4.16 times more likely to die of cancer, 2.26 times more likely to die of heart disease and 2.58 times more likely to die from any cause than were former or nonsmokers. Current smokers were also more likely to suffer a heart attack or stroke.
There were no significant differences between former smokers and nonsmokers in the risk for dying from heart disease or any cause, but former smokers were more likely to die of cancer than those who’d never smoked.
“The analysis provides further strong evidence that people with heart disease who continue to smoke take a very high risk of increasing their chances of death in the short term,” principal investigator Dr. Deepak L. Bhatt, chief of cardiology at the Veterans Affairs Boston Healthcare System, said in a news release from the American Heart Association.
“This study provides impetus for a smoker to stop,” he said. “The benefits of risk reduction accrue relatively quickly when someone stops smoking, although the lingering cancer risk is still there.”
The study was published online Nov. 23 in Circulation.
More information
The U.S. Centers for Disease Control and Prevention has more about the health effects of smoking.
— Robert Preidt
SOURCE: American Heart Association, news release, Nov. 23, 2009
Last Updated: Nov. 24, 2009

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Heart Disease

Ginkgo Won’t Prevent Heart Attack, Stroke in Elderly.


Among people aged 75 and older, the herbal supplement Ginkgo biloba does not prevent heart attacks, stroke or death, a new study finds.
There is some evidence that the popular herbal remedy might help prevent the leg-circulation problem known as peripheral artery disease, however.
Ginkgo contains nutrients called flavonoids, which are also found in fruits, vegetables, dark chocolate and red wine, and are believed to offer some protection against cardiovascular events, the researchers say. The supplement, which is popular in the United States and Europe, has been touted to improve memory, and to prevent dementia, heart disease and stroke.
However, “ginkgo had no benefit in preventing heart attack or stroke,” said study lead researcher Dr. Lewis H. Kuller, distinguished university professor of public health and professor of epidemiology at the University of Pittsburgh.
“But, surprising to us, was that the results were consistent with the observations in Europe that ginkgo appeared to have some benefit in preventing peripheral vascular disease,” he said.
This could be due to flavonoids acting as both antioxidants and also causing blood vessels to expand, Kuller said.
The report was released online Nov. 24 in advance of publication in an upcoming print issue of the journal Circulation. Last year the same University of Pittsburgh team reported that ginkgo biloba had no effect on preventing dementia.
For their latest study, Kuller’s group randomly assigned 3,069 patients to 120 milligrams of highly purified ginkgo biloba or placebo, twice a day as part of the Ginkgo Evaluation of Memory Study.
Over the six years of the trial, 385 participants died, 164 had heart attacks, 151 had strokes, 73 had mini-strokes (“transient ischemic attacks”) and 207 had chest pain, the researchers found.
There was no significant difference between those taking ginkgo or placebo for any of these outcomes, Kuller said.
However, among the 35 people who were treated for peripheral artery disease, 23 received placebo and 12 were taking ginkgo — a statistically significance difference, the researchers noted.
About 8 million Americans have peripheral artery disease, which typically affects the arteries in the pelvis and legs. Symptoms include cramping and pain or tiredness in the hip muscles and legs when walking or climbing stairs, although not everyone who has PAD is symptomatic. The pain usually subsides during rest.
“This study demonstrated that there were absolutely no benefits of ginkgo biloba in reducing cardiovascular events such as heart attack or stroke or in reducing death due to cardiovascular disease,” said Dr. Gregg A. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.
“Individuals interested in maintaining cardiovascular health should stick to interventions that have been proven to be beneficial, including not smoking, engaging in regular exercise, and maintaining healthy weight, blood pressure and cholesterol levels rather than taking herbal supplements,” Fonarow said.
Mark Blumenthal, founder and executive director of the American Botanical Council, which represents the herbals industry, pointed to the study’s more positive outcome.
“I believe it is important to emphasize that the results of this current exploratory trial do not in any manner reduce or negate the existing positive results of ginkgo biloba as an effective treatment in peripheral artery disease patients, which has been evaluated, confirmed, and approved by government regulatory drug authorities in leading Western European countries like Germany and France,” he said.
In addition, Blumenthal said, the trial showed that ginkgo biloba was safe and well-tolerated.
More information
Find out more about ginkgo biloba at the U.S. National Library of Medicine.
By Steven Reinberg
HealthDay Reporter
SOURCES: Lewis H. Kuller, M.D., Dr.P.H., distinguished university professor, public health and professor of epidemiology, University of Pittsburgh; Mark Blumenthal, founder and executive director, American Botanical Council; Gregg A. Fonarow, M.D., professor, cardiovascular medicine, University of California, Los Angeles; Nov. 24, 2009, Circulation, online
Last Updated: Nov. 24, 2009

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Cholesterol Plays Role in Heart Failure Risk

Abnormal cholesterol levels can significantly increase the risk of heart failure, a new study has found.
U.S. researchers analyzed data on 6,860 participants in the National Heart, Lung, and Blood Institute’s Framingham Heart Study. None of the participants, average age 44, had coronary heart disease at the start of the study. After about 26 years of follow-up, 680 people had developed heart failure.
The incidence of heart failure was:

• 12.8 percent in participants with low levels of high-density lipoprotein (HDL, or “good”) cholesterol. Low HDL is less than 40 milligrams per deciliter (mg/dL) in men and less than 50 mg/dL in women.
• 6.1 percent among participants with desirable HDL levels (at least 55 mg/dL in men and 65 mg/dL in women).
• 13.8 percent in participants with high levels (at least 190 mg/dL) of non-HDL cholesterol, which includes triglycerides and low-density lipoprotein (LDL, or “bad”) cholesterol.
• 7.9 percent in those with desirable levels (less than 160 mg/dL) of non-HDL cholesterol.

When the researchers factored in age, sex, body mass index, blood pressure, diabetes and smoking, the risk of heart failure was 29 percent higher in participants with high non-HDL cholesterol than in those with lower levels, and 40 percent lower in those with high HDL-cholesterol than in those with lower levels.
Further analysis showed that the risk of heart attack was 13 percent higher in participants with high non-HDL cholesterol and 25 percent lower in those with high HDL cholesterol.
“This study goes a step further in implicating cholesterol levels (both HDL and non-HDL) in heart failure and suggests that cholesterol-altering therapy may have long-term benefits in preventing heart failure above and beyond its effects on preventing [heart attack],” study senior author Dr. Daniel Levy, director of the Framingham Heart Study, said in a news release from the American Heart Association.
The study is published in the Nov. 23 online edition of the journal Circulation.
More information


The American Heart Association has more about cholesterol.
—  Robert Preidt
SOURCE: American Heart Association, news release, Nov. 23, 2009
Last Updated: Nov. 24, 2009

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MRSA Creeping Into Hospitals From the Outside

Strains of antibiotic-resistant infections normally found in the community are increasingly showing up among hospital outpatients, raising the risk that inpatients could become infected, new research says.
From 1999 to 2006, researchers found a sevenfold increase in the incidence of outpatients with methicillin-resistant Staphylococcus aureus (MRSA) infections. Outpatients include people treated in emergency departments or surgical centers but not admitted, or at doctors’ offices associated with hospitals.
This poses a risk to inpatients because many resources are used by both sets of patients. These include surgical centers and the doctors themselves, who often treat patients both inside and outside of hospitals.
“What this is suggesting is that outpatients are a significant source of MRSA, especially community-associated MRSA strains,” said the study’s lead author, Eili Klein, a doctoral candidate at Princeton University and a researcher at Resources for the Future, a Washington, D.C.-based think tank. “This suggests the need for incentives to make sure hospitals are not only taking steps to prevent hospital-associated strains from spreading among inpatients, but preventing the spread of community-associated strains through shared resources.”
The study is published in the December issue of Emerging Infectious Diseases.
MRSA, which burst into the public consciousness in the 1990s, is named for its resistance to methicillin and other antibiotics. There are several strains, including those that emerged in hospitals, called “hospital associated,” and those that emerged outside hospitals and tend to spread in schools and gyms, called “community associated.”
While both types can cause serious, life-threatening illness, hospital-acquired strains are generally more virulent. The bacteria can get into wounds, causing deadly blood or lung infections. About 20,000 people in the United States die each year from the MRSA infections, according to background information in the study.
Community-associated strains have also caused some deaths in otherwise healthy people, including several children who were killed by MRSA infections in the late 1990s. Typically, however, community-associated strains cause skin or other soft tissue infections that are treatable with newer antibiotics.
According to the research, the number of hospital-associated infections remained relatively stable from 1999 to 2003, even decreasing a bit from 2003 to 2005. Some of the reduction was due to better infection-control measures, such as more thorough and frequent hand washing among doctors, Klein said.
Community-associated strains, however, are becoming far more commonplace. Among outpatients with staph infections, MRSA infections increased by more than 90 percent, according to the data culled from 300 microbiology labs serving hospitals across the nation.
Most of the increase was due to community-associated strains, which rose from 3.6 percent of all MRSA infections in 1999 to 28.2 percent in 2006, the study found.
The increases pose a risk to hospital inpatients, who may become infected by contaminated equipment in surgical centers used for inpatients and outpatients or by the doctors themselves.
The study did not find an increase in hospital-associated strains spreading in the community.
After hearing reports of community-associated MRSA strains showing up in hospitals, the U.S. Centers for Disease Control and Prevention analyzed the data it has collected on invasive MRSA infections, said Dr. Fernanda Lessa, a CDC medical epidemiologist.
The CDC report found that the proportion of community-associated MRSA infections in hospitals, compared with MRSA infections overall, remained small and that the infections were no more virulent than those already present.
“So far it hasn’t been a big problem,” Lessa said. “Our data suggested the community-associated strain doesn’t seem to be taking off in hospitals and is not causing worse disease.”
Other research also has shown a rise in community-associated strains. A study in the January issue of Archives of Otolaryngology Head & Neck Surgery found that MRSA infections in the ears, nose or sinuses of children more than doubled from 2001 to 2006, going from 12 percent to 28 percent of head-and-neck area infections.
More information
The U.S. Centers for Disease Control and Prevention has more on MRSA.
By Jennifer Thomas
HealthDay Reporter
SOURCES: Eili Klein, doctoral candidate, Princeton University, Princeton, N.J., and researcher, Resources for the Future, Washington, D.C.; Fernanda Lessa, M.D., M.P.H., medical epidemiologist, division of healthcare quality promotion, U.S. Centers for Disease Control and Prevention, Atlanta; December 2009, Emerging Infectious Diseases
Last Updated: Nov. 24, 2009

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9 Signs You Might Be Headed for a Holiday Meltdown

By Sarah Klein
Let’s face it. Some holiday-related stress is to be expected. Turkeys will be burned. Flights will be canceled. You probably won’t be the one to nab that $50 flat-screen TV on Black Friday, even if you get up really, really early.
When Lori Kimble was a girl, a snowstorm knocked out the power at her grandparents’ house just as the holiday feast was due to hit the oven. “We ended up having to roast the turkey in the fireplace and use a camping stove to cook the rest,” says Kimble. “We ate by candlelight too.”
Heartwarming? Or holiday horror story? The thing is, you get to decide. Stress happens, but how you react to it determines how the holiday will be remembered.
Holiday stress does hit some people harder than others. For example, women are more likely than men to report additional stress during the holidays, and they are less likely to take the time needed to deal with stress in healthy ways, according to a 2006 study from the American Psychological Association (APA).
“The more we have ongoing and chronic stress, the more that can lead to physical ailments and concerns,” says Angela Londoño-McConnell, PhD, a psychologist and the president at AK Counseling & Consulting, in Athens, Ga.
So how can you become one of those people who chuckles at adversity—silly snowstorm!—instead of crying into your eggnog? Here are nine signs you could be headed for a holiday meltdown, and how to stop the implosion before it happens.
1. You have super-high expectations.
If you tend to feel stress year-round because you’re not meeting the expectations you’ve set for yourself, the holidays are likely to amplify these feelings.
“We have high expectations to have the Martha Stewart holiday, but [what if] we’re not good at baking, or our family just doesn’t get along?” says Stephanie S. Smith, PsyD, a clinical psychologist at Front Range Psychological Associates, in Erie, Colo. Sometimes expectations are so unrealistic they simply can’t be fulfilled, she says.
What you should do:
Focus on what is realistic—not ideal—or you risk facing major disappointment when things don’t go as planned. Perfectionists must remember that preparing for a holiday is not a one-person task; reaching out to a support system to delegate tasks can really lighten the load.
Now would also be the time to crank up your sense of humor and keep it on full blast until January.
2. You tend to overbook.
Chances are, the holiday invitations are hitting your inbox and mailbox. Between the office party, neighbors’ open house, family obligations, and one-day sales, you can be stretched—too thin.
Packing your calendar with obligations means sacrificing time usually spent on other activities. Sleep and exercise—important stress relievers—could be the first to go.
What you should do: Get ready to say no to some things. Start to prioritize chores, decline some invitations, and schedule time to do holiday activities you enjoy, instead of just those you feel you have to do.


3. You have family friction.
If you have overbearing parents or passive-aggressive siblings, the holidays can amplify trouble in already strained relationships. Tension can escalate, especially if you are spending longer periods of time with family than you are used to or staying with or hosting family members.
What you should do: The best thing you can do? Manage your expectations.
“If you have a strained relationship the other 11 months of the year, you’re probably going to be disappointed if you have the expectation of having a loving, cozy holiday,” says Smith. “Don’t expect things in reality that are out of the realm of possibility.”
Be sure to take time for yourself, even if you are hosting visitors. “You want to spend time with [out-of-town family], but that doesn’t mean you can’t go out for your walk every morning, or have coffee by yourself,” says Smith. “We should still allow ourselves to do the things we typically do to make ourselves feel good or get us through the day.”
4. You cut back on sleep to get everything done.
You’re up at the crack of dawn to rush to the best sales and then stay up late to wrap gifts or clink glasses at parties. But the holidays shouldn’t mean kissing your good night’s sleep good-bye.

Skimping on sleep can leave you grumpy and stressed, throw off your diet, and increase your risk of colds, depression, and car accidents. Traveling across time zones or sleeping in a bed that isn’t your own can also throw off your normal sleep routine. Read more about how the holidays can affect your sleep.
What you should do: Make a good night’s sleep a priority.
“At some point I think that we just need to realize that there is only so much of us to go around,” says Londoño-McConnell, “and we need to make some decisions about how it is that we really want to spend our time.”
5. You tend to drink more when stressed.
Sometimes a glass of red wine is the perfect antidote to a long, stressful day. It also may have some health benefits: A daily serving of alcohol may improve your memory or protect your heart.
But excessive drinking can spell trouble, making you more susceptible to colds and the flu, as well as increasing the risk of breast cancer, uterine cancer, and osteoporosis in the long term. Unfortunately, 14% of people say they drink more to cope with holiday stress.
Because alcohol is a depressant, overindulging could make you more emotional, leaving you more open to a major meltdown.
What you should do: Experts recommended limiting your alcohol intake to one or two drinks a day. Sure, that can be tough when faced with a mandatory office party, but if you can’t stick to your limit, do yourself a favor by ducking out of the party early.
6. Your clothes are feeling tight­—already.
Before you know it, the leftover turkey sandwiches, Christmas sugar cookies, and afterwork cocktails can really add up. Studies have shown that many people gain a couple of pounds over the holidays and have trouble losing them later.
The weight gain could be part of a vicious cycle: Holiday eating is stressing you out and the holiday stress is making you eat. “People tend to eat more, or not eat as well when they’re stressed,” says Londoño-McConnell.
What you should do: Instead of packing on the pounds, enjoy holiday meals guilt-free by planning ahead for the splurge. That way you can indulge smartly without derailing your diet.
7. You’re strapped for cash.
Let’s face it—2009 wasn’t nice to a lot of people. If a change in your work life or finances is a dark cloud hanging on the holiday horizon, you’re not alone.
Even before the economy bottomed out, Americans said financial pressures caused holiday stress. In a 2006 APA survey, 61% of respondents listed lack of money as the top cause of holiday stress, followed closely by the pressures of gift giving at 42%. Credit card debt also ranked highly, at 23%.

While more recent data isn’t yet available, experts assume that financial pressures are even higher today. “Given the economy, money is still an issue,” says Londoño-McConnell. “Typically, it is already a stressor, so it’s probably going to continue.”
What you should do: Although it’s tough, now is the time of year to ask for help if you need it. From meals to toys for your kids, religious groups and other charitable organizations are there to help you.
If you were lucky enough to make it to the end of 2009 without needing a helping hand, then offer one to others.
“I think in this financial crisis, most of us have taken stock of what really matters,” says Londoño-McConnell. “It’s forcing us in some ways to get back to basics, and that might actually not be so bad.
8. You’re struggling with depression or another health problem.
The holidays can be particularly trying for people with depression, bipolar disorder, and anxiety, as well as for people who have lost close friends and family members.
Feeling depressed at this time of year “can be particularly hard because we’re expected to be happy,” Smith says. “You can feel more depressed because you feel like you’re out of the loop.” But these feelings are legitimate, and the holidays are no reason to put mental health on the back burner.
What you should do: Being open and honest about these emotions ahead of time will take some of the pressure off of staying cheery on the big day. If you’ve lost someone recently or are depressed due to financial problems, talk with family members before the holidays and decide which traditions you want to keep and which may be too painful or expensive to continue.
9. You’re married to tradition.
Traditions are one of the sweetest parts of the holidays. You always eat your Thanksgiving turkey fried with a side of cranberry. You always spend Christmas in Biloxi. But, sorry—times change. You lost your job this year. Or your new husband, a vegetarian, says if he’s not in Houston, it’s not a holiday. Now what?
What you should do: Treasure your traditions, but be open to new ones. Sometimes the holidays don’t look exactly as we remember them or how we think they should look—or taste.
Take a look at how your life has changed in the past year, either financially or in terms of your relationships. Be flexible and willing to compromise—holidays are about more than what you eat and where you eat it, or about a gift’s price point.
Better to break the traditions, not the relationships. Keep your eye on what really matters—thankfulness, giving, sharing, and caring.

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