Experts Issue New Heart Disease Guidelines for Women

The American Heart Association has updated and sharpened its guidelines for preventing heart disease in women.

The focus now is on a woman's lifetime risk for heart disease, not just her short-term risk, as was the case in the 2004 guidelines.

The 2007 Guidelines for Preventing Cardiovascular Disease in Women are published this week in a special issue of the journal Circulation devoted to women's health, and were outlined at an AHA press conference Tuesday.

Among other things, the guidelines refresh recommendations on aspirin use, hormone replacement therapy and vitamin and mineral supplementation.

"The new updated guidelines are extremely exciting, because they advance our science quite a bit and our ability to provide guidance to physicians and other health care providers on the best practices for prevention for women," said Dr. Lori Mosca, chair of the American Heart Association's (AHA) expert panel that devised the guidelines. She is also director of preventive cardiology at New York-Presbyterian Hospital in New York City.

Heart disease among women is practically epidemic, accounting for one in three female deaths.

"Cardiovascular disease is the leading cause of death among women," Mosca said. "The rate of awareness among women has increased from 30 to almost 60 percent, but we still need to work on the confusion around preventive strategies. We are very encouraged that the release of these new guidelines can help clear up some of this confusion and help our women engage in more conversations with physicians and health care providers as to what are the best strategies to reduce the burden of the number-one killer of women."

Here are the high points of the new guidelines, which incorporate the latest science from recent randomized, controlled trials:

• Where once women were classified as being at high, intermediate or low (optimal) risk for heart disease, they are now considered high, at-risk or optimal (the latter group representing probably no more than 10 percent of women). The new stratification incorporates, but does not rely solely on, the conventional Framingham Score that doctors use to assess cardiovascular risk. It also takes into account lifetime risk, not just short-term risk. "We wanted to align more with clinical trial evidence and acknowledge that cardiovascular disease is so ubiquitous in women," Mosca said.
• Expanded lifestyle interventions include a continued emphasis on quitting smoking and avoiding secondhand smoke. This time, the guidelines also recommend counseling, nicotine replacement or other forms of smoking cessation therapy.
• All women are still urged to exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate-intensity activity on most, or preferably all, days of the week.
• A heart-healthy diet should still be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
• Saturated fat should now be reduced to less than 7 percent of calories (the previous guidelines stated 10 percent).
• Women should eat oily fish, a source of omega-3 fatty acids, at least twice a week. "This is not recommended for all women but can be considered a balance of benefit and risk for women at high risk," Mosca said.
• Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL. Otherwise, high-risk women are still encouraged to lower their LDL to less than 100 mg/dL.
• Women aged 65 and over should consider taking low-dose aspirin on a routine basis, regardless of their risk. Aspirin has been shown to prevent both heart attacks and stroke in this age group.
• Women under 65 should not be taking aspirin routinely, as it has been shown only to have a benefit for stroke prevention.
• The upper dose of aspirin for high-risk women is now 325 mg per day, up from 162 mg.
• As stated in the previous guidelines, neither hormone replacement therapy, selective estrogen receptor modulators or antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
• Folic acid should also not be used to prevent cardiovascular disease, a major change from the last set of recommendations.

The current issue of Circulation also included heart information from several other studies:

• Age, rather than health care disparities, seems to explain why more women than men die in the hospital after a heart attack. "The differences in death rates are largely due to differences in age when the heart attack occurred and not due to differences in treatment," said Dr. Alice Jacobs, professor of medicine at Boston University School of Medicine, who was also involved with the new guidelines.
• Differences in an estrogen gene (ESR1) do not appear to affect the risk of heart attack and stroke in response to hormone replacement therapy, as was previously thought. The gene may, however, be associated with an elevated risk of breast cancer.
• Some 40 percent of postmenopausal women have "pre-hypertension," associated with a 58 percent higher risk of cardiovascular death, said researchers from the Women's Health Initiative. It's unclear if intervening in this group will reduce cardiovascular problems, Jacobs said.
• Supplementation with calcium/vitamin D had no effect on heart disease and stroke risk in postmenopausal women who were generally healthy.
• Estrogen, when delivered by patch or gel, does not seem to increase the risk of blood clots in the vein (venous thromboembolism or VTE). Only estrogen taken orally seems to increase this risk.

http://12.31.13.13/healthnews/healthday/070219HD602048.htm

Experts Offer Dos and Don'ts of Walk-In Clinic Care

The number of retail walk-in clinics in the United States is expected to double by the end of this year, and older adults need to know when it's appropriate to use these clinics and when they should see their doctor instead, says the American Geriatrics Society.

The society offers the following list of Dos and Don'ts for elderly people:

• Clearly explain to the walk-in clinic's health care professional all of your medical problems and any allergies or problems you have with medications.
• Bring a complete list of your current medications and ask the clinic health care provider to check the list to be certain that the drugs on the list agree with any new medications the clinic doctor may prescribe.
• Get a report from the clinic with your diagnosis and follow-up instructions. Take that report with you the next time you see your geriatrician or primary care doctor.
• Don't go to a retail medical clinic if you have major new symptoms such as chest pain, shortness of breath, or leg swelling. These symptoms require immediate attention by your doctor.
• Don't go a retail medical clinic if you notice a change with a medical problem that you've had for a long time and is already being treated by your doctor. See your own doctor.
• Don't use these clinics if you've had a cough for three or more weeks. This situation requires special medical attention.
• Don't use a retail medical clinic for the majority of your health care. These clinics provide only basic tests and treatments.

http://12.31.13.13/healthnews/healthday/070224HD601802.htm

Weekends Worst Time for Stroke

Strokes treated on the weekend are more deadly than those attended to on a weekday, Canadian researchers report.

And while the study included only Canadians, the best guess is that the difference in outcome might be even worse in the United States, said Dr. Gustavo Saposnik, assistant professor of medicine at the University of Toronto and lead author of a report in the journal Stroke.

"We don't have information on what's going on in the United States," Saposnik said. "But here, we have universal health insurance with no co-payment. With all the different plans in the United States, it might be a little worse."

Saposnik and his colleagues had information on almost 26,700 people admitted to 606 Canadian hospitals for ischemic stroke from April 2003 to March 2004. Ischemic strokes occur when a clot blocks a brain artery. More than 80 percent of strokes are ischemic; the rest are hemorrhagic, occurring when an artery bursts.

Just about a quarter of those people came to the hospitals on Saturdays or Sundays. After adjusting for age, gender and other complicating factors, the researchers found that people admitted on a weekend had a 14 percent higher risk of dying within seven days than those who came in on weekdays. They were also less likely to survive to go home.

This "weekend effect" was greater for people admitted to rural rather than urban hospitals and if the physician in charge was a general practitioner rather than a specialist, the study found.

The reasons for the difference are not clear, Saposnik said. "There may be some differences in resources in different hospitals on weekends," he said. "We are doing another study trying to address the underlying mechanism for our findings."

Whatever the reason, the experts' advice to people who suspect someone may be having a stroke remains the same no matter what the day of the week, Saposnik said.

"No matter what the time of day, in a rural or an urban area, they should seek medical attention," he said. "Call 911 and get to the nearest emergency department."

Quick action is needed because, in a stroke, "time means brain," Saposnik said. In other words, faster treatment means fewer brain cells will die.

That rule was emphasized by Dr. Larry B. Goldstein, professor of medicine and director of the stroke center at Duke University and chairman of the American Heart Association's Stroke Council.

He offered another suggestion for those who believe a loved one might be experiencing stroke: "Don't put a person in a car. It could be something other than a stroke. Just call 911, and hopefully the system will make sure that the patient gets to the appropriate facility."

Appropriate help should be available "24/7," Goldstein said. There is a national system for accrediting round-the-clock stroke centers, and states including New York, Florida and Massachusetts have their own accrediting mechanisms, he said.

"The difference in weekend admissions found in this study may be real, but the potential benefits of early treatment well outweigh the risk of waiting," Goldstein said.

Stroke symptoms include abrupt difficulty in speaking or understanding, weakness or numbness of an arm or leg and unexpected difficulty walking, he said.

http://12.31.13.13/healthnews/healthday/070308HD602575.htm

Religious Faith May Speed Stroke Recovery

Strong religious faith may help reduce emotional distress that can hinder recovery from stroke, Italian research shows.

The study included 132 stroke survivors (median age 72) who were interviewed about their religious beliefs and spirituality.

Lower levels of belief/spirituality were associated with higher levels of depression and anxiety. The reason for this association is not clear, but one possibility is that religiously active people may have more social support, the study authors said.

"Religious people who are active in their communities are more likely to receive external aid that can be provided by volunteers," Dr. Salvatore Giaquinto, chairman of the department of rehabilitation at the San Raffaele Pisana Rehabilitation Center in Rome, said in a prepared statement.

"Social support lets them experience feelings of care, love and esteem. The new experience of support and the background of faith tell the patients that they are not alone," Giaquinto said.

While unique, this research does not offer any solid evidence, Dr. Lalit Kalra, a stroke professor at King's College London School of Medicine in England, wrote in an accompanying editorial in the journal Stroke.

"The study does not establish that religious beliefs will definitely reduce emotional distress but shows that people who are religious have better coping abilities. Hence, both these variables may define personal attributes of the patient, in other words, religious beliefs do not make a person cope better but identify patients who have better abilities to cope with chronic illness," Kalra said.

http://12.31.13.13/healthnews/healthday/070215HD601918.htm

Airbag Deployment Could Cause Permanent Hearing Loss

Permanent hearing loss will occur in 17 percent of people exposed to airbag deployment in cars sold in the United States, new research suggests.

Dr. G. Richard Price, a consultant at Auditory Hazard Analysis in Charlestown, Md., only looked at cars with front and side airbags sold in the United States, which are required to have larger, more powerful airbags than cars sold in Europe and other parts of the world. Cars with smaller airbags likely pose less of a hearing threat, Price said.

He also found that, contrary to widespread belief, car occupants are more likely to suffer hearing damage when the windows are rolled down.

Experts had believed that having the windows rolled up was more dangerous to hearing, because there'd be more pressure inside the car. Price said he found that the higher pressure caused by airbag deployment in cars with rolled up windows actually prevents greater damage to the ear.

The increased pressure with the windows rolled up actually causes a displacement in the middle ear that stiffens the stapes, which is a small bone outside the inner ear, according to Price. The stiffening of the stapes limits transmission of energy to the inner ear, where hearing damage occurs.

In fact, experiments showed that hearing damage is further reduced when a passenger cabin is completely sealed, resulting in even higher pressure when airbags deploy, Price said.

In a presentation scheduled to be made Friday in Savannah, Ga., at the National Hearing Conservation Association's (NHCA) annual meeting, Price is also expected to discuss the danger to hearing posed by everyday "impulse" noises -- brief bursts of sound such as a hammer hitting a nail or even the sound of a baby's rattle.

Price's work offers a glimpse at an aspect of new technologies people rarely think about, said NHCA Director of Education Brian Fligor.

"We often consider only the benefits of safety technology, rather than the unfortunate potential side effects. This type of study highlights how common everyday occurrences present a very real hazard to our hearing," Fligor said in a prepared statement.

http://12.31.13.13/healthnews/healthday/070216HD601926.htm

Stages of Grief Theory Put to the Test

New research challenges and confirms some of the commonly held beliefs about the process of grieving.

The study found that for older people mourning a death by natural causes, a yearning or pining for the lost loved one, and an acceptance of their loss, come first in the grieving process.

That's at odds with the standard "five stages of grief " theory held by psychologists that lists disbelief, yearning, anger, depression and acceptance as the phases of emotions bereaved individuals typically pass through.

Instead, "this study basically shows that yearning is the dominant negative grief symptom following the loss, not disbelief, sadness or depression," said Holly Prigerson, director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston. "And, overall, the main reaction was a high degree of acceptance," she added.

The researchers found that soon after a death, acceptance becomes the most commonly felt emotion for the bereaved, rather than the expected disbelief or depression. Acceptance is also the last emotion to reach its peak, they noted.

The study is published in the Feb. 21 issue of the Journal of the American Medical Association.

The researchers also found that negative emotions such as anger had largely peaked by six months after the loss. This suggests that if someone seems stuck in their grief after this time period, they may be having a more difficult time coping with their loss and may need counseling or additional support.

The five stages of grief theory has evolved over time but originally was developed as a four-stage theory of grief: shock-numbness, yearning-searching, disorganization-despair and reorganization. Then, world-renowned psychiatrist, Dr. Elisabeth Kubler-Ross wrote a book called On Death and Dying, which adapted the four-stages of grief into a five-stage response of the terminally ill to their impending death. This work evolved into the five stages of grief commonly recognized today, according to background information in the study.

"The five stages have been accepted as gospel and truth without study. There's been no previous empirical research," said Prigerson.

And, that's where this study comes in. To test the five stages of grief, renamed in this study as the five indicators of grief, Prigerson and colleagues from Yale University School of Medicine recruited 233 adults living in Connecticut who had recently lost a loved one to participate in the study.

The study participants were predominantly white (97 percent), mostly spouses of the deceased (84 percent) and were an average of almost 63 years old. All of their loved ones had died of natural causes and had non-traumatic deaths. According to the study authors, this population represents the typical bereaved person in America.

The study volunteers were interviewed at about six, 11 and 20 months after the loss of the loved one.

The researchers devised a grief indicator scale of one through five to indicate how strongly a grief emotion was being felt. A score of five meant that emotion was felt very strongly.

In the first six months after the loss, the average score for acceptance was 4.11, and yearning was 3.77. Depression was the next most common emotion with a score of 2.29, followed by disbelief with 2.27 and anger at 1.87.

During the next six months, all of the negative grief indicators, with the exception of depression, went down, and the level of acceptance went up. Depression scores stayed the same in the six- to 12-month period following the loss. During the next 12 months, all of the negative grief indicators declined, while acceptance continued to rise.

"Negative grief indicators peak at six months post-loss," said Prigerson.

"The expression of grief is a very complex phenomenon with a great deal of individual variability," said Shirley Otis-Green, a senior research specialist at City of Hope National Medical Center in Duarte, Calif.

And, that expression doesn't necessarily follow an orderly timeline, said Kristin James, coordinator of the Heartlight Program, a family bereavement program at Children's Memorial Hospital in Chicago.

"It's important to attempt to quantify grief if you can, but while this study may describe what happens on average, there are so many events that can spark these emotions again. It's not easy to say that at one month or at six months you should be done with this emotion," said James.

James said that especially with non-typical deaths -- the type that weren't studied here -- it's difficult to pin down what's "normal" grief and what's not. For example, she said, if a child loses a parent, they may just be starting to grieve at around six months, because grieving is often delayed in children.

http://12.31.13.13/healthnews/healthday/070220HD602064.htm

Bone up on bone health

It's time today to bone up on a key health issue: osteoporosis, a potential killer that starts early in life but that is largely preventable.

The spur for this item is a recent study published in the Journal of the American Medical Association that evaluated the bone status of a staggering 200,000 post-menopausal women.

How did the researchers manage to examine so many women?

Easy - they set up their equipment in shopping malls and outside movie theatres showing "chick flicks".

Just kidding, of course. These women were actually seen in a wide variety of locations because the researchers used equipment that measures the density of "peripheral" bones such as the heel, and which is more portable than standard "bone density machines" that focus on larger bones such as the hip.

The researchers found that an amazing 40 % of post-menopausal women have "low" bone density, and over 7 % have established osteoporosis.

Even worse, by the time they were assessed, 11 % of the women had suffered some type of fracture, yet they had not been put on appropriate therapy to lessen the risk of future fractures.

This study should act as a wake-up call to everyone to get serious about bone health: not only doctors and women of all ages, but men, too, since a recent Canadian study found that osteoporosis may be much more common in men than previously believed.

The reason we need to pay more attention to this condition is that fractures, which get more common with age - about 40 % of women break a bone at one point in their lives, particularly in the hip, the vertebra, and the wrist - not only lead to pain and disability, they kill lots of people, too - about 25 % of hip fractures lead to death.

So you want to keep your bones strong, boys and girls, and although genetics plays a role in osteoporosis (the risk is higher in some families, as well as Asians and Caucasians), the good news is that there is much you can do.

First, for parents, get your kids on a bone health regime as early as possible (although I don't want to discourage any geezers reading this because it's probably never too late to make appropriate changes). But the earlier the better, because like certain other body parts, bones, too, grow bigger until early adulthood, and it's very important to lay down as much early bone as possible - the more bone laid down and the better it's maintained through middle age and beyond, the more bone you can afford to lose as you reach dowager status.

And what do you have to do? Simple - clean up your acts.

First, eat better focusing on more calcium-rich dairy products - yes, that means drinking more milk instead of pop.

Give up smoking, and (perhaps) limit your caffeine intake, too.

And probably the hardest, but for me, the most important thing - get off your ample butts. Weight-bearing exercise is crucial for adequate bone strength. And it doesn't have to be complicated exercise - one study, for example, found that jumping up and down fifty times a day is a good way to maintain bone strength, advice that clearly should be used with caution by anyone living in a third floor condo.

http://chealth.canoe.ca/channel_section_details.asp?text_id=2010&channel_id=10&relation_id=3901