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Abnormal Heart Rhythm Linked to Alzheimer’s

July 29th, 2010

People with atrial fibrillation, a form of abnormal heart rhythm, are more likely than others to develop dementia, including Alzheimer’s disease, a new study finds.

The presence of atrial fibrillation also predicted higher death rates in dementia patients, especially among younger patients in the group studied, meaning under the age of 70.

“This leaves us with the finding that atrial fibrillation, independent of everything else, is a risk factor [for dementia],” said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. “This is adding one more brick in the road toward understanding that cardiovascular disease is a major risk factor for dementia.”

“Alzheimer’s disease, in particular, is one where we don’t quite understand the risk factors and what causes it, so studies [like this] that try to investigate the causative effect will help us understand that and ultimately design therapies and approaches to prevent or minimize disease,” added Dr. Jared Bunch, lead author of a study appearing in the April edition of the HeartRhythm Journal and a cardiologist/ electrophysiologist with Intermountain Medical Center in Murray, Utah.

This study, however, was not specifically set up to establish a direct cause-and-effect relationship.

The authors looked at 37,025 patients without atrial fibrillation or dementia, aged 60 to 90, over a five-year period.

Individuals who developed atrial fibrillation had a higher risk of all types of dementia, even when other risk factors were taken into account. Alzheimer’s disease is by far the most common form of dementia.

More surprising was that those in the younger group — under age 70 — who had atrial fibrillation had the highest risk of developing dementia, even though dementia is normally associated with aging. People in this group were also at a 38 percent higher risk of dying.

Among the 764 patients who developed both conditions, diagnosis of atrial fibrillation usually happened first, followed by a diagnosis of dementia. Sometimes the diagnoses occurred simultaneously, the researchers noted.

The authors hypothesized that both atrial fibrillation and dementia may arise from the same risk factors, such as hypertension. Another possibility is that atrial fibrillation increases inflammation, and dementia has been shown to be higher in people with signs of systemic inflammation. Investigating whether treatment of hypertension and/or inflammation in AF patients might help curb the risk of dementia is an area of future study, the researchers added.

“From a public health perspective, the best thing we can do to decrease the coming epidemic of Alzheimer’s disease is to do a much better, more aggressive job of helping people with heart disease,” Kennedy said. “That means diet and exercise, of course — everyone knows that. We need to look at obstacles that people encounter beyond their own behavior, obstacles we put up environmentally in the workplace, in the school, that keep people from having better diet and exercise. A heart-healthy diet and lifestyle are really the best means we have available to prevent dementia.”

About 2.2 million Americans have atrial fibrillation, while an estimated 5.5 million suffer from Alzheimer’s.

SOURCES: Jared Bunch, M.D., cardiologist and electrophysiologist, Intermountain Medical Center, Murray, Utah; Gary Kennedy, M.D., director, geriatric psychiatry, Montefiore Medical Center, New York City; 2010 Heart Rhythm Journal

Device Avoids Open-Heart Surgery When Artificial Valve Fails

July 19th, 2010

If an artificial heart valve derived from a cow or pig fails to work properly, researchers say implanting a mechanical valve inside the artificial valve could be an option for high-risk patients.

“Once expanded and opened, the new valve opens and functions similarly to the patient’s own valve. The advantage is that failing surgical valves can be replaced without the need for open-heart surgery,” study lead author Dr. John G. Webb, medical director of Interventional Cardiology and Interventional Research at St. Paul’s Hospital in Vancouver, Canada, explained in an Ameruican Heart Association news release.

Webb and colleagues report on 24 high-risk patients who underwent surgery that transplanted a new artificial valve into the existing artificial one. The valves were inserted through a catheter — either via a tiny incision between the ribs, or through a leg blood vessel — and expanded with the help of balloons that pushed the old valves away.

The strategy isn’t appropriate in all cases. Still, “patients may recover more rapidly, and the concerns about major surgery are reduced,” Webb said.

The researchers report that the traditional treatment — a new open-heart operation — is very risky.

The study was reported in the journal Circulation.

Hospitalization Appears to Help Personality Disorder Patients

July 8th, 2010

Long-term symptom remission is common among patients after they’ve been hospitalized because of borderline personality disorder, says a new study.

The disorder is characterized by chronic unhappiness, frequent changes in mood, irrational thoughts, impulsivity and unstable interpersonal relationships.

The study included 290 patients who were evaluated every two years after their release from the hospital. After 10 years of follow-up, 86 percent of the patients had sustained remission of symptoms.

While achieving concurrent symptom remission and good psychosocial functioning seems difficult for many borderline personality disorder patients, this recovery is relatively stable once it’s attained, said Mary Zanarini and colleagues at McLean Hospital in Massachusetts.

The researchers suggested that treatment for borderline personality disorder should include a rehabilitative component that focuses on social and work skills.

“Improving interpersonal relationships and job performance is a large part of the goal for many patients and their families. A rehabilitation approach might also have the practical effect of reducing the percentage of patients who receive Social Security disability benefits, and, equally important, it could help alleviate some of their feelings of low self-worth,” Zanarini stated in a news release from the American Psychiatric Association.

The study was published online in the American Journal of Psychiatry.

Herb shows no added benefits for women’s bones

June 30th, 2010

Exercise may help older women maintain their bone density, but adding the supplement black cohosh to the routine does not bring any extra benefits, a new study suggests.

Researchers found that among 128 postmenopausal women they studied for one year, those who were randomly assigned to regularly exercise generally maintained their bone density. In contrast, women who were assigned to a “wellness” group that got only light, infrequent exercise showed a decline in their bone density, on average.

But while exercise appeared to help women hang on to their bone mass, the herb black cohosh showed no added effects. Among exercisers, those who were randomly assigned to take the supplement each day showed no bone-density advantage after one year.

Black cohosh extracts are marketed as a “natural” form of hormone replacement therapy and most commonly used to treat hot flashes and other symptoms of menopause. Some lab research, but not all, suggests the herb may have estrogen-like activity in the body.

The new study appears to be the first to look at the effects of black cohosh on bone density, according to lead researcher Michael Bebenek of the University of Erlangen, in Germany.

While in theory, a substance with estrogen-like effects could protect women’s bone density, the benefits of black cohosh for bone health is “still doubtful,” Bebenek told Reuters Health in an email.

He and his colleagues report the findings in the medical journal Menopause.

For their study, the researchers recruited 128 women who had gone through menopause within the past one to three years.

They randomly assigned 86 women to an exercise program that interspersed six weeks of higher-intensity activities designed to protect bone mass — like high-impact aerobics and strength training — with 10 weeks of more-moderate exercise designed to improve heart health. The latter included activities like brisk walking and step aerobics.

Half of the exercisers also took a 40-milligram black cohosh supplement each day.

The remaining 42 women were assigned to a “wellness” group that performed low-intensity activities, like light walking, stretching and balancing exercises, for one hour a week.

After one year, women in both exercise groups showed no significant change in bone density at the spine, while those in the wellness group showed a 2 percent decline, on average. Exercisers had a slight increase in bone mass at the hip — about 0.5 percent — versus an average dip of 0.6 percent in the wellness group; that difference was not, however, significant in statistical terms.

The researchers found no significant bone-mass differences between exercisers on black cohosh and those who did not take the supplement.

Bebenek’s team also looked for any changes in the study participants’ Framingham risk scores — an estimate of a person’s odds of suffering a heart attack or dying from heart disease in the next 10 years. The score is based on age, smoking history, blood pressure and cholesterol levels and whether a person has diabetes.

Overall, the researchers found no clear effects of exercise or exercise-plus-black-cohosh on the women’s risk scores.

At the end of the study, women in the exercise-only group were estimated to have a 6 percent chance of suffering a heart attack or dying from heart disease in the next 10 years; that risk was 7 percent and 7.8 percent in the black cohosh and wellness groups, respectively. However, the differences in the groups’ score changes over time were not significant in statistical terms.

The bottom line, according to the researchers, is that the study “again clearly demonstrated” the positive effects of exercise on postmenopausal women’s bones. Whether black cohosh has any bone-health benefits, however, remains in question.

High Fructose Corn Syrup Linked to Liver Scarring

June 20th, 2010

New research links consumption of high-fructose corn syrup, the extremely popular sweetener that shows up in food products from ketchup to jelly, to liver damage in people with non-alcoholic fatty liver disease.

It’s not clear if the sweetener directly causes liver scarring, also known as fibrosis, but those who consumed more of the sweetener appeared to have more liver scarring, according to the report released online in advance of publication in an upcoming print issue of the journal Hepatology.

“We have identified an environmental risk factor that may contribute to the metabolic syndrome of insulin resistance and the complications of the metabolic syndrome, including liver injury,” Dr. Manal Abdelmalek, associate professor of medicine in the division of gastroenterology/hepatology at Duke University Medical Center and leader of a team of scientists behind the new research, said in a university news release.

The researchers examined the medical records of 427 adults with non-alcoholic fatty liver disease (NAFLD), along with questionnaires the patients completed about their diets.

Only 19 percent of adults with non-alcoholic fatty liver disease said they never drank beverages containing the sweetener; 29 percent did so every day, the investigators found.

“Non-alcoholic fatty liver disease is present in 30 percent of adults in the United States,” Abdelmalek said in the news release. “Although only a minority of patients progress to cirrhosis, such patients are at increased risk for liver failure, liver cancer, and the need for liver transplant. Unfortunately, there is no therapy for non-alcoholic fatty liver disease. My hope is to see if we can find a factor, such as increased consumption of high-fructose corn syrup, which if modified, can decrease the risk of liver disease.”

Representatives of the corn refining industry took issue with the findings, noting that the study involved a wide range of sources of fructose, not just beverages sweetened with high-fructose corn sugar.

Furthermore, “fructose has not been proven to be a cause of NAFLD in humans, and NAFLD subjects are compromised individuals with significant health problems which have very little to do with fructose intake,” according to a news release from the Corn Refiners Association released late Friday.

“Moreover, associative studies of this kind are widely judged to be of low scientific value when trying to establish cause-and-effect, data from studies like this that are dependent on recollection of the study subjects are notoriously imprecise, and these studies are full of confounding variables and exceedingly difficult to control,” the CRA added.

Hypoglycemia May Raise Risk of Death in ICU Patients

June 10th, 2010

Mild to moderate hypoglycemia (low blood sugar) increases the risk of death in critically ill patients, a new study shows.

It included 4,946 critically ill patients at six medical centers in Australia, Japan and New Zealand. Of those patients, 1,109 experienced hypoglycemia while the remainder served as a non-hypoglycemic control group.

It had been believed that mild to moderate hypoglycemia was clinically unimportant. But this study found that patients with hypoglycemia had a death rate of 36.6 percent, compared with 19.7 percent for those without hypoglycemia.

“Even after the adjustment for insulin therapy or timing of hypoglycemic episode, the more severe the hypoglycemia, the greater the risk of death,” study co-investigator Dr. Rinaldo Bellomo, of Austin Health in Melbourne, said in a news release.

“Our results suggest that any tolerance of mild to moderate hypoglycemia by intensive care clinicians may be undesirable. In this regard, newer technologies such as continuous glucose monitoring in the ICU setting might help avoid hypoglycemia or identify it earlier,” Bellomo said.

The study appears in the issue of Mayo Clinic Proceedings.

Makers pledge to add safeguards to CT scanners

May 31st, 2010

An industry group representing the top five manufacturers of CT equipment said on Thursday the companies will add new safeguards to their machines to help prevent patients from being exposed to too much radiation.

The Medical Imaging & Technology Alliance said manufacturers will add a color-coded warning system to give health care providers clear warning when they are doing scans that give patients potentially dangerous doses of radiation.

A CT or computed tomography scan gives doctors a view inside the body, often eliminating the need for exploratory surgery.

But CT scans deliver a much higher radiation dose than conventional X-rays. A chest CT scan exposes the patient to more than 100 times the radiation dose of a typical chest X-ray. High doses of radiation can cause skin burns, cataracts and other injuries.

The new safeguards would apply to machines made by General Electric, Toshiba Corp, Hitachi Ltd, Siemens and Philips.

The changes, which would be phased in starting this year, would provide a yellow alert screen when the dose is higher than expected. It would also offer a red alert warning when a patient is about to be given a dangerous dose of radiation.

The system would also allow hospitals and imaging centers to set their machines to prevent these scans from being done.

“Some of our companies will be able to provide features before the end of this year based on when new releases become available,” Dave Fisher, executive director of the alliance, told reporters in a telephone briefing.

The group also promised that it will standardize the way radiation doses are recorded.

“The dose information would be saved in a standard format, making it easier to integrate the information into a national dose registry, identical to what the president identified as one of the goals in his budget,” Fisher said.

The changes follow the U.S. Food and Drug Administration’s call earlier this month for makers of CT machines and other medical imaging equipment to add new safety features to their machines.

Fisher said the alert system “will definitely be included in new equipment. It also is going to be included in some versions of older equipment.”

On Friday the group will testify before the Committee on Energy and Commerce’s Health subcommittee hearing on radiation exposure.

The FDA said in December it was investigating several cases of patients who received up to eight times the normal level of radiation from brain scans performed with equipment from GE and Toshiba.

CT scan use in the United States has grown sharply. About 70 million CT scans were done on Americans in 2007, up from 3 million in 1980.

(Editing by Eric Walsh)

Health Tip: Understanding Dry Mouth

May 24th, 2010

Dry mouth usually affects older adults, often as a side effect of a health condition or certain drugs including decongestants, antihistamines, pain relievers and diuretics, says the American Dental Association.

Symptoms of dry mouth may include a sore throat, a burning sensation, hoarse voice, nasal dryness and difficulty speaking and swallowing. If frequent dry mouth isn’t treated, it can lead to tooth damage and decay.

Saliva is needed to keep the mouth moist, get rid of food build-up, and neutralize acids created by plaque that damage the teeth, the association says.

Dry mouth also can irritate oral tissues. This can lead to inflammation and increased risk of infection. See your dentist for prompt treatment, the ADA advises.

Health Tip: Getting Preventive Services

May 23rd, 2010

Good health means more than being treated only when you’re sick. It also means taking steps to stay healthy in the first place.

The American Academy of Family Physicians offers these examples of preventive services:
Screenings to evaluate your health and check for medical problems. Some tests differ for women and men, such as those for ovarian cancer and prostate cancer respectively.
Tests to measure health barometers such as blood pressure, blood cholesterol and weight.
Getting advice from your doctor about your diet and exercise routines; use of tobacco, alcohol and drugs; stress levels; and steps you take to prevent injuries and accidents.
Immunizations.