Statins May Reduce the Risk of Certain Eye Diseases

Cholesterol-lowering medications known as statins appear to improve circulation in the eye, potentially reducing the risk of certain eye diseases such as diabetic retinopathy, according to Japanese researchers reporting in the May issue of the journal Archives of Ophthalmology.


While statins previously have been shown to reduce the risk of stroke and heart disease even in patients without high cholesterol, the effect of statins on blood circulation in the retina had not been studied previously.

The researchers randomly assigned 12 healthy men (average age 21 years) to receive either a 20-milligram dose of simvastatin or an identical placebo each morning for seven days. They measured blood flow in the men's retinal arteries and veins at the beginning of the study, 90 minutes after administering the drug the first day and at the end of seven days. They also assessed the participants' blood intraocular pressure, or the pressure within the eyeball.

Among the patients taking statins, intraocular pressure was reduced 90 minutes after taking the medication and at the seven-day mark. Blood velocity (speed) and blood flow were significantly increased in patients who had taken statins for seven days, although the size of the blood vessels did not change.

These findings may have implications for several eye diseases, the authors reported. Diabetic retinopathy, which occurs when poorly controlled diabetes damages the eyes and which can lead to blindness, recently was linked to reduced blood flow in the eye.

"The increased retinal blood flow associated with treatment with simvastatin may be a potential therapy for diabetic retinopathy," the authors concluded.

New Surgical Technique May Offer Alternative for Treating Glaucoma

A new surgical technique may offer an alternative for treating glaucoma, according to researchers at the Weizmann Institute of Science in Rehovot, Israel.

Open-angle glaucoma occurs when fluid pressure builds up inside the eye causing damage to the optic nerve, vision impairment and pain. Traditional surgery uses incisions to allow the extra fluid to escape to another area of the eye where it can be reabsorbed into the bloodstream.

The new, less invasive technique, called enzymatic sclerostomy, uses an enzyme that can be selectively activated on the eye to increase the release of fluid from within the eye, lowering the pressure of the eye in patients with open angle glaucoma, according to the study published in the Archives of Ophthalmology.

The procedure, when tested on 15 patients blinded by open-angle glaucoma, showed immediate and sustained reduction of eye pressure. However, the procedure needs further technical refinement, according to the researchers.

Black Patients Found Less Likely to Receive Chemotherapy for Lung Cancer

African Americans diagnosed with lung cancer are less likely to see an oncologist and subsequently less likely to receive chemotherapy, largely because of their socioeconomic status, according to researchers at Harvard University.

Researchers studied 12,015 patients over age 65 who were diagnosed with metastatic lung cancer between 1991 and 1996 and monitored by a Survival, Epidemiology, and End Results (SEER) tumor registry.

Of the patients who were not treated with chemotherapy, 36 percent were never assessed by a physician who provided chemotherapy. Patients living in particular areas, those diagnosed in more recent years, and patients who received care in a teaching hospital were all more likely to have seen a cancer specialist, according to the study published in the Journal of Clinical Oncology. These factors were not related to subsequent treatment decisions.

Age and the presence of other illnesses did not have a significant effect on whether a patient was seen by an oncologist, but were linked with the likelihood of their receiving subsequent chemotherapy.

Investigators concluded, "Nonmedical factors are important determinants of whether a lung cancer patient is seen by a physician who provides chemotherapy. After seeing such a physician, treatment decisions seem to be mostly explained by appropriate medical factors. Racial and socioeconomic disparities still exist at both steps, however."

"Referring physicians must ensure that biases and barriers to care do not deprive patients of the opportunity to consider all of their treatment options," the study advised.

Vitamin A and Derivatives Have Protective Effect Against Tobacco-Caused Lung Cancer

Vitamin A and its natural and synthetic derivatives called retinoids have been shown to have a protective effect against tobacco-caused lung cancer but this effect is suppressed by nicotine, according to researchers at the Burnham Institute in La Jolla, California.

Researchers analyzed human lung cancer cells that were treated with a variety of retinoids and found that nicotine inhibited the protective action of the retinoids, according to the study published in the International Journal of Cancer.

Researchers concluded that the inhibition of retinoid activity by nicotine may contribute to the lack of effectiveness of retinoids in cigarette smokers. They also found that some retinoids may be more effective than others in preventing tobacco-linked cancers.

Sigmoidoscopy May Miss Half of Colon Cancers in Elderly

A new study by Japanese researchers has found that over half of colon cancers in the elderly may be missed if sigmoidoscopy is used for screening in place of colonoscopy.

The explanation lies in the fact that the frequency of right-sided colon cancer increases with patient age, and the sigmoidoscope does not reach the right side of the colon.

The researchers said that in 191 patients who were found by colonoscopies to have colon cancer, the proportion with right-sided colon cancer rose steadily from a low 15 percent of those under 50 years of age to a high of 57 percent for those over age 80.

"Over half of colon carcinomas may be missed if sigmoidoscopy alone is used for screening," the researchers reported in Gastrointestinal Endoscopy. "The frequency of right-sided colon cancer increases with patient age. Hence, colonoscopy may be indicated in the elderly for colorectal cancer screening."

Age, Income, Insurance All Factors in Determining Treatment

Researchers in the state of Washington report that age, income level and insurance coverage all are significant factors in the determination of what treatments are recommended for patients with colorectal cancer.

The researchers linked Washington State's cancer registry and hospital discharge records to U.S. census data to assess the socioeconomic and demographic factors that go into treatment decisions.

Reporting in the journal Cancer, the researchers said patients over the age of 75 were at higher risk of having a treatment plan that did not include radiation or chemotherapy after surgery than patients under age 65.

The likelihood of no post-operative treatment was also more than double for patients in zip codes with the lowest per capita income compared to those in middle and upper-income zip codes.

The likehood of no post-operative treatment was also much higher for patients covered by Medicare compared to private insurance, the researchers said.

"The current findings suggest disparities in the provision of recommended medical procedures related to socioeconomic and demographic factors," the researchers concluded.

Drinking Milk or Eating Cheese May Help Fight Colorectal Cancer

When you drink milk or eat a slice of cheese, you may be helping fight colorectal cancer, according to a University of Texas (UT) Southwestern Medical Center at Dallas researcher.

Dr. Clifford Simmang, director of colon and rectal surgery at the medical center, said the calcium in these foods may help reduce risk for colon cancer.

Simmang said recent research suggests foods high in calcium, as well as calcium supplements, help prevent polyp formation in the colon, a risk factor for colorectal cancer. The supplements also may protect against the advanced polyps most associated with the invasive form of the disease.

“Results from studies are still coming in, but indications are calcium does help prevent polyp formation,” said Simmang.

To reduce your risk for the disease, Simmang suggests adhering to current daily dietary recommendation for calcium – 1,000 milligrams for people age 19 to 50 and 1,200 milligrams for those over 50. That’s equivalent to between three to four eight-ounce glasses of skim milk a day.

“There really is no best dose to recommend,” said Simmang. “Most people, though, should stay on the high side of the daily recommended dose.”

Few African American Women Recognize They Are at High Risk of Colorectal Cancer

An astonishing 96 percent of African American women do not consider themselves to be at high risk of colorectal cancer, despite having the greatest risk of any gender, race or ethnicity of developing and dying from the disease, according to a new Harris survey.

As a result of this misperception, 70 percent of African American women still do not heed the American College of Gastroenterology (ACG) guidelines for African Americans to begin colorectal cancer screenings at age 45.

According to the survey, only 6 percent of African American women over 45 discussed colorectal cancer when they last saw their doctor because they didn't think they were at particular risk (27 percent), their doctor didn't bring it up (15 percent), or they didn't think there was a reason to (16 percent).

In an effort to increase awareness, the Black Women's Health Imperative and the National Women's Health Resource Center (NWHRC) have launched an educational initiative that confronts the issues preventing African American women from getting screened and seeking treatment.

"Colorectal cancer is not color blind and it has a penchant for African American women," said Lorraine Cole, CEO of the Imperative.

"Our mission is to let every African American woman in this country know why it's so critical for them to get screened early. We're also giving them tools to help them take action against this deadly but beatable disease," added Elizabeth Battaglino Cahill, RN, executive director, NWHRC.

If colorectal cancer is detected while still in the localized stage, the five-year survival rate in all African Americans is 83 percent.

"Getting beyond our own fear and learning the facts can go a long way in improving our survival and quality of life," said Edith Mitchell, clinical professor of medicine and program leader in gastrointestinal oncology, Thomas Jefferson University. "Colorectal cancer is not a death sentence, so don't let that stop you from asking your healthcare provider about screening and, if colon cancer is found, treatment. Colorectal cancer is not only treatable but beatable."

Breast Cancer Patients Want More Involvement in Treatment Decisions

Surgeons need to be more responsive to a breast cancer patient's need to be involved in treatment decisions, according to Harvard Medical School researchers.

Researchers developed a study to describe desired and actual roles in treatment decision-making among patients with early-stage breast cancer, identify how often patients' actual roles matched their desired roles, and examine whether matching of actual and desired roles was linked with the type of treatment they received and their satisfaction with that treatment.

A total of 1,081 women with early-stage breast cancer were surveyed about their desired and actual roles in treatment decision making with their surgeon. Investigators assessed whether the matching of actual to desired roles was linked with the type of surgery the women received and their rate of satisfaction.

Sixty-four percent of the patients wanted a collaborative role in decision-making, but only 33 percent reported having such a role when they discussed their treatments with the surgeon. Forty-nine percent of the women reported an actual role that matched their desired role. Twenty-five percent had a less active role than they desired and 26 percent had a more active role than they desired, reported the researchers.

Patients whose reported actual role matched their desired role were no more likely than other women to undergo breast-conserving surgery, but these women were more satisfied with their treatment choice than those whose role was less active or more active than desired, according to the study published in the Journal of Clinical Oncology.

Overall, approximately half of patients reported an actual role in decision-making that matched their desired role.

On-Site Mobile Mammography Seen as Effective Way to Reach Older Women

On-site, mobile mammography at community sites is an effective way to reach older women who would not ordinarily get screened for breast cancer, according to researchers at the University of California at Los Angeles.

Researchers looked at a sample of 500 women between the ages of 65 and 84 who had not had a mammogram in the previous year. The women who participated in the study were found at community-based sites, senior centers and clubs and all received on-site multi-component health education. At half of the locations, randomly selected participants were given the opportunity to receive a mammogram.

At the sites where mammography was offered, 55 percent of the women opted to have the screening within three months. Only 40 percent of the women at the other sites underwent screening over the same period of time.

Mobile mammography was particularly effective for three groups with traditionally low screening rates: Asians, Hispanics and low-income women. Thirty-three percent of the women who had never been screened opted to have a mammogram when they had access to a mobile unit. Only 12.5 percent of the women at sites where only health education was available opted to get a mammogram.

Researchers concluded that mobile mammography "is an effective method to increase breast cancer screening among older women."

Obese Women at Higher Risk of Dying From Breast Cancer

Postmenopausal women who are obese are at a higher risk of dying from breast cancer than normal or underweight women, according to researchers at the American Cancer Society.

Approximately 30 percent of breast cancer deaths in women may be linked to their weight, according to the study published in the journal Cancer Causes and Control.

Previous studies have found that overweight and obese women are at a higher risk of death from breast cancer. However, most studies have not been large enough to test the link across a wide range of body mass and postmenopausal breast cancer deaths, wrote the researchers.

Investigators analyzed the relation between body mass index and height and postmenopausal breast cancer deaths in a study of U.S. adults enrolled in the American Cancer Society's Cancer Prevention Study II in 1982.

After 14 years of follow up, 2,852 deaths from breast cancer were seen among 424,168 postmenopausal women who were cancer-free at the start of the study.

Researchers found that death from breast cancer increased with increasing body mass index. Breast cancer deaths among women 5-foot tall to 5-foot-6 also increased with each inch, but did not further increase in women over 5-foot-6.

"Postmenopausal obesity is an important and potentially avoidable predictor of fatal breast cancer in this study," concluded the researchers. "These results underscore the importance of maintaining moderate weight throughout adult life.

Acupuncture Effective in Reducing Nausea and Vomiting After Breast Surgery

Acupuncture is more effective at reducing nausea and vomiting with fewer adverse side effects after major breast surgery than the leading medication, according to a study reported in the September 22 issue of the journal Anesthesia and Analgesia.

Researchers at Duke University Medical Center also found that patients who underwent acupuncture reported decreased postoperative pain and increased satisfaction with their postoperative recovery.

About 70 percent of women who undergo major breast surgery requiring general anesthesia suffer from postoperative nausea and vomiting, according to Tong Joo Gan, MD, the Duke anesthesiologist who led the trial. These adverse side effects are important factors in determining how soon patients can return home after surgery.

"The patients in our randomized trial who received acupuncture enjoyed a more comfortable recovery from their surgery than those who received an antisickness medication," Gan said.

In the trial, Gan employed an electro-acupuncture device in which an electrode is attached at the appropriate pressure point. In this case, the point is known as P6 and is located below the wrist. Instead of actually breaking the skin with the traditional long slender needles, the electro-acupuncture device delivers a small electrical pulse through the skin.

"Electro-acupuncture enhances or heightens the effects of traditional acupuncture," Gan explained. "Also, in the busy and complicated setting of the operating room, the electro-acupuncture device is much more convenient to use."

The researchers enrolled 75 women who were to undergo major breast surgery (mastectomy, breast augmentation and breast reduction) requiring the use of general anesthesia. They were then randomized into three groups: one which received acupuncture, one which received the medication Zofran® (ondansetron) and a group that received neither.

The surgeries lasted anywhere from two to four hours, and the incidence of postoperative nausea and vomiting and pain were tracked at 30-minute intervals for the first two hours after surgery, and then again 24 hours later.

Two hours after surgery, 77 percent of the patients receiving acupuncture experienced no postoperative nausea and vomiting, nor did they require an antiemetic drug to reduce nausea and vomiting, compared to 64 percent for those who received ondansetron and 42 percent who received nothing. At 24 hours, the rates were 73 percent, 52 percent and 38 percent, respectively.

According to Chinese healing practices, there are about 360 specific points along 14 different lines, or meridians, that course throughout the body just under the skin.

While pressure on other acupuncture points – LI4 on the hand, SP6 on the leg and "back-shu" along the spine – are known to have pain-killing effects, this is the first to show that P6 also has analgesic effects to go along with its known antiemetic properties, Gan said.

While it is not completely known why or how acupuncture – whether electro-acupuncture or traditional – works, recent research seems to point its ability to stimulate the release of hormones or the body's own painkillers, known as endorphins, Gan said.

The researchers will conduct further studies comparing the various combinations of these frequencies, as well as comparing the combination of acupuncture with other antiemetic medications.

Study to Examine Sisters of Breast Cancer Patients for Environmental and Genetic Causes

The National Institute of Environmental Health Sciences (NIEHS) will study the environmental and genetic causes of breast cancer among sisters of women diagnosed with breast cancer

Enrollment for the Sister Study opened October 18 across the United States. NIEHS is an arm of the National Institutes of Health. The study is the largest study of its kind to look at breast cancer risk factors.

Women of all backgrounds and ethnic groups are eligible for the study if they are between the ages of 35 and 74 and live in the United States. While participants must have never had breast cancer themselves, they must have a sister -- living or deceased -- who has had breast cancer.

The Sister Study will take the most detailed look ever at how women’s genes and things women come in contact with at home, work and in the community may influence breast cancer risk.

“By studying sisters, who share the same genes, often had similar experiences and environments, and are at twice the risk of developing breast cancer, we have a better chance of learning what causes this disease,” said lead researcher Dale Sandler, Ph.D.

At the beginning, volunteers will complete several questionnaires and provide a sample of their blood, urine, toenails and household dust.

“With that, we’ll be able to look at how genes, activities of daily life and exposure to different things in our environment are related to breast cancer risk,” Sandler said. “We’ve made the process as easy and as convenient as possible, so we will come to you.”

The landmark study will stay in touch with the volunteers for 10 years and compare those who develop breast cancer with the majority who do not.

Estrogen-Only HRT Does Not Up Breast Cancer Risk If Taken for Less Than 10 Years

Postmenopausal women who take estrogen-only hormone replacement therapy for less than 10 years do not increase their risk of developing breast cancer, but the risk goes up significantly if they take the hormone replacement pills for more than 20 years, according to a new study.

Hormone replacement therapy (HRT) is widely prescribed for women in menopause who are experiencing unpleasant symptoms such as hot flashes, sleep disturbances, depression, mood swings, and anxiety. HRT can help control these side effects.

The study, published in the May 8 edition of the journal Archives of Internal Medicine, found that breast cancer risk actually decreased slightly during the first 10 years of estrogen-only HRT use. (The number of cancer cases during this period was too small to make this finding statistically significant.)

But breast cancer risk increased by a statistically significant 42 percent for women who took HRT for more than 20 years. Moreover, the risk of hormone-responsive breast cancer, the most common form of breast cancer, increased by 48 percent for women who took HRT for at least 15 years.

The researchers also reported that thinner women taking estrogen HRT for more than 20 years had a 77 percent higher risk of developing breast cancer, while overweight women had a 25 percent increased risk of breast cancer after 20 years of estrogen HRT.

HRT can contain estrogen alone, progesterone alone, or a combination of the two hormones. The Wall Street Journal reported that about 3.5 million of the 4.4 million U.S. women currently taking HRT are taking the estrogen-only form.

The research was based on Harvard University's Nurses' Health Study, and looked at estrogen use among 28,835 nurses and whether long-term use affected risk for breast cancer.

Breast Cancer Patients Who Take Yoga May Function Better Physically

Women who take yoga classes during radiation treatment for breast cancer may function better physically and feel better about their overall health, according to M.D. Anderson Cancer Center researchers

The researchers on June 4th presented the results of a small study involving 61 breast cancer patients at the annual scientific meeting of the American Society of Clinical Oncology.

"The main objective of this study was to examine the feasibility of integrating a daily yoga program into the treatment care plan for women with breast cancer undergoing radiation treatment, and determine if this is something the patients found useful and enjoyable, as well as assessing aspects of their quality of life," said Lorenzo Cohen, irector of the Integrative Medicine Program at M. D. Anderson.

In the study, the patients -- with Stage 0 to Stage 3 breast cancer -- were randomized to participate in the yoga classes twice weekly at, or around, the time of their radiation appointments, or, as the control group, to be offered yoga post-treatment.

The yoga program was designed specifically for breast cancer patients, emphasizing breathing and relaxation, and excluding some positions that mighe be difficult given the patients' possible weakened range of motion.

After just one week of yoga and radiation, the patients reported significantly increased physical function, as well as improved general health, compared to the control group.

The study participants also reported marginally better social functioning, significantly lower levels of sleep-related daytime dysfunction, as well as marginally lower levels of fatigue overall. No differences in the level of depression or anxiety were found between the two groups.

As a result of the findings, M.D. Anderson is conducting a follow-up study, funded by the National Cancer Institute, in breast cancer patients receiving radiation comparing yoga to stretching exercises and standard care.

Optimism Produces More Pain Relief for Arthritis Sufferers

Arthritis sufferers who are optimistic about pending hip or knee surgery are going to experience better pain relief than patients who have low expectations, according to researchers at the University Health Network in Toronto, Canada.

Researchers evaluated the relationship between patient expectations of total joint arthroplasty and their satisfaction with the results six months after the procedure. Arthroplasty is joint surgery in which both joint surfaces are replaced with artificial materials, usually metal and high-density plastic.

The study included 102 patients undergoing total hip arthroplasty and 89 undergoing total knee arthroplasty. The average age of the patients was 66 years. The patients were evaluated using questionnaires given before surgery and six months afterwards.

All of the patients in the study achieved significant improvements in their condition following surgery. Patient expectations regarding their surgery were not linked with their age, gender, joint being operated on, marital status or race. Expectations were not linked to the patient's health status before surgery.

The expectation of complete pain relief after surgery was an independent predictor of better physical function and pain improvement at six months after surgery. The expectation of low risk of complications from total joint arthroplasty was an independent predictor of greater patient satisfaction, according to the study published in the Journal of Rheumatology.

"Patient expectations were important independent predictors of improved functional outcomes and satisfaction following total joint arthroplasty," concluded the researchers. "Greater understanding of the relationship between expectations and outcomes may improve the process of care and outcomes of total joint arthroplasty."

Smoking Increases Risk of Rheumatoid Arthritis in Certain People

Smoking significantly increases the risk of rheumatoid arthritis among men and women with a genetic predisposition for the disease, according to a study reported in the October issue of Arthritis & Rheumatism.

The team of Swedish researchers investigated the interaction of two specific rheumatoid arthritis risk factors: cigarette smoking and the presence of a protein sequence called the shared epitope, the major genetic risk factor for the disease. The shared epitope is found in cell surface molecules that regulate specific immune responses.

The researchers studied 858 rheumatoid arthritis patients whose average age was 49 years as well as 1,048 healthy individuals to serve as controls.

Participants donated blood samples for DNA genotyping. Every participant also completed lifestyle questionnaires, including smoking habits.

The DNA samples of the rheumatoid arthritis patients were studied for evidence of genes for the shared epitope. The blood samples were also tested for rheumatoid factor, a hallmark of this disease. The researchers then compared current smokers with those who had never smoked for their risk of developing rheumatoid arthritis.

People with the shared epitope gene who never smoked had a 2.8 times greater risk of developing rheumatoid arthritis, compared to 2.4 times for current cigarette smokers without the gene. Among current smokers with the gene, however, the disease risk increased to 7.5 times.

Beyond strengthening the case against cigarette smoking as a health hazard, this study has important implications for ongoing research into the factors contributing to rheumatoid arthritis and other autoimmune diseases.
"Our study also emphasizes the need to include data on environmental exposures in genetic analyses of a complex disease," the authors concluded.

Blood Fat Content May Be Early Indication of Increased Risk of Rheumatoid Arthritis

An unfavorable ratio of such blood fats as total cholesterol, HDL (good) cholesterol and triglycerides could indicate an increased risk of rheumatoid arthritis as much as 10 years later, according to Dutch researchers.

Reporting in the Annals of Rheumatic Diseases, the researchers said they analyzed 1,078 deep frozen blood samples from 79 people who had given blood between 1984 and 1999 and subsequently went on to develop rheumatoid arthritis, and compared the fat content to samples from 1,071 randomly selected blood donors.

The researchers looked at levels of total cholesterol, high density lipoprotein (good) cholesterol, triglycerides, apolipoproteins A and B, and lipoprotein (a).

They found that people who subsequently developed rheumatoid arthritis had a more unfavorable balance of circulating blood fats than those who did not develop the disease, with total cholesterol on average 4 percent higher, HDL levels 9 percent lower, triglycerides 17 percent higher and apolipoprotein B 6 percent higher.

The researchers said the same people also had an increased risk of ischaemic heart disease, in which the artery walls are thickened and hardened by fat deposits, possibly helping explain the link between a higher rate of cardiovascular disease among patients with rheumatoid arthritis.

Long-Term, Intensive Exercise Improves Body's Ability to Control Glucose Levels

Long-term, intensive exercise can greatly improve the body's ability to control blood sugar levels, helping to stall the development of diabetes or cardiovascular disease in at-risk patients, according to researchers at Duke University Medical Center.

The benefits of an exercise program are still at work one month after the exercise is discontinued and just one single session of exercise can immediately improve glucose metabolism, the researchers reported in the journal Clinical Exercise Physiology.

"It now appears that there is also a long-term beneficial effect from regular exercise, most likely due to the fact that a significant a mount of fat is lost," said Cris Slentz, PhD, exercise physiologist and author of the study. "Long-term exercise leads to loss of fat in the gut region, which is especially beneficial since this fat is thought to be directly linked to increased risk of diabetes and heart disease.'

Researchers put five overweight and sedentary people on a nine-month intensive exercise program consisting of four exercise sessions each week, beginning with 15 minutes each day and increasing to 60 to 70 minutes daily. The program included stationary bike riding, treadmill, walking and stair climbing. After nine months, the participants spent one month in a "de-training" program.

The participants' blood glucose and insulin levels were measured before the start of the training, and again one day, five days and 30 days afterward. The blood samples were taken after eight-hour fasts so the results would not be influenced by what the participants were eating.

"Insulin sensitivity, or its ability to stimulate glucose metabolism, was higher after nine months of exercise, and the fasting insulin levels were lower," said Slentz. "Just as importantly, 30 days after stopping exercise, insulin sensitivity was still 24 percent higher than pre-exercise levels, indicating that beneficial effects of exercise persisted."

"These results provide strong evidence that long-term exercise training can lead to both short- and long-term improvements in carbohydrate metabolism," said Dr. William Kraus, cardiologist and senior researcher. "This demonstrates the clinical significance of regular exercise in preventing the development of insulin resistance and glucose intolerance in patients at risk for diabetes and heart disease."

wo Drugs With Insulin Are Better Than One for Avoiding Weight Gain

Two drugs combined with insulin are better than one in regulating the blood-sugar levels of type 2 diabetics without the common side effect of weight gain, according to a study reported in the July issue of Diabetes Care.

Type 2 diabetics being treated with drugs typically take insulin and only one of the drugs. Such patients often lower their blood sugar below the 7 percent limit suggested by the American Diabetes Association, but they also tend to gain weight and to increase their insulin doses.

University of Texas Southwestern Medical Center researchers say they are the first to analyze the safety and effectiveness of triple therapy using insulin, metformin and a drug in the thiazolidinedione family.

"We've shown spectacular control of blood sugar levels in the absence of weight gain, a common side effect of drug therapies for type 2 diabetes," said study author Dr. Philip Raskin, a UT Southwestern professor of internal medicine. "And we can keep the blood sugar under control with relative ease. This is a step in the right direction for effectively treating type 2 diabetes."

In the UT Southwestern study, all 28 patients who used triple therapy reduced their blood-sugar levels below 7 percent without increasing insulin. Patients who took the therapy in a particular order, with the thiazolidinedione administered after a period of insulin and metformin use, actually showed a slight decrease in weight, along with lowering blood sugar.

Almost 60 percent of all patients, regardless of what order the drugs were taken, reduced blood sugar levels below 6 percent.

Keeping blood-sugar levels under 6 percent or 7 percent significantly reduces the risk of eye disease, kidney disease and amputations, said lead researcher Suzanne Strowig, a UT Southwestern faculty member.

Drugs like metformin and those in the thiazolidinedione family help the body regulate the amount of glucose in the blood and decrease the amount of glucose made by the liver. They also help the body more effectively use its own insulin, according to the researchers.

"With many of these drugs, though, people have been unable to control their weight," Raskin said. "But put together, especially in a particular order, they show the most promise.

Diabetics With Carpal Tunnel Syndrome Can Benefit From Surgery

Diabetics with Carpal Tunnel Syndrome (CTS) can benefit from surgery, according to a study recnelty presented at the annual meeting of the American Association of Electrodiagnostic Medicine in Savannah, Georgia.

Some in the medical community have questioned whether diabetics who undergo surgery for CTS release actually improve. Surgery is sometimes recommended to remove or release compression of the median nerve, the nerve that passes from the forearm to the palm.

Hee-Kyu Kwon, M.D, of Korea University Hospital in Seoul, and her colleagues compared the outcomes of CTS release surgery in diabetic and non-diabetic patients.

The groups were evaluated using several electrodiagnostic tests. Physicians use electrodiagnostic procedures to diagnose problems created when the electrical signals within nerves and muscles become weakened or stop altogether.

No meaningful difference in outcomes between the two groups was found.

Kwon and her colleagues concluded that physicians should consider surgery as a viable treatment for diabetic patients with symptomatic CTS.

Changes Needed to Improve End-of-Life Care for Dementia Patients

A new study by University of Chicago geriatricians has found that changes are needed to improve the end-of-life care for patients with dementia.

An estimated 500,000 people die every year in the United States suffering from Alzheimer's or related diseases. Many patients receive inadequate pain control and ineffective and invasive therapies such as tube feedings. Many patients also do not receive the benefits of hospice care, according to the study.

"The nature of the illness is the root cause of the problem," said study author Greg Sachs, M.D., professor of medicine at the University of Chicago. "Our health care system is oriented toward treatment of acute illness but dementia produces a long, slow, unpredictable decline."

As reported in the October issue of the Journal of General Internal Medicine, the study focuses on impediments and solutions to adequately caring for dementia patients with chronic and ultimately terminal illness.

The geriatricians explained that the first hurdle to adequate end-of-life care is the unwillingness of physicians and families to think of dementia as a terminal illness, adding that such patients decline slowly, with long periods of stability punctuated by sudden declines and partial recovery.

A second barrier, according to the study, is the inability of physicians to predict the time of death. While Medicare and most insurance plans offer hospice benefits to patients with a life expectancy of six months or less, the average survival for patients with dementia is actually several years and varies enormously.

A third barrier, the geriatricians point out, is the poor fit between dementia and health care financial incentives, which reward providers for transferring rapidly declining patients into hospitals where the process of dying is prolonged. "The only parties who may not be better off from the transfer," note the authors, "are the patient and family."

Potential solutions center around education, better prognostic tools and changes in the health care system, the study authors emphasize. Most urgent, they write, is a nationwide effort to align the financial incentives in the system with the provision of palliative care.

Such an allignment would include allowing hospice to accommodate earlier referral of patients with dementia and rewarding nursing homes for providing good end-of-life care rather than for transferring dying patients to a hospital.

Researchers Report Failure of Aging Brain's Ability to Clean House May Cause Alzheimer's

Researchers report that Alzheimer's disease, which gradually robs millions of sufferers of their memories, may be caused by a failure of the brain's natural ability to clean house as it ages.

Reporting in the journal Science, the researchers said their study marks the first identification of a genetic link between aging and the onset of Alzheimer's disease, which strikes more than one in 30 Americans.

Professor Jeffery Kelly of Scripps Research and Professor Andrew Dillin of the Salk Institute's Molecular and Cell Biology Laboratory made their discoveries studying a roundworm called c elegans – a widely used animal model.

The study found that toxicity from protein aggregation, which appears to cause Alzheimer's, is "drastically reduced" when aging is slowed by modulating the insulin growth factor (IGF) signaling pathway.

Moreover, the researchers found two novel independent activities promoting this cellular survival. The first protective mechanism disassembles and cuts up protein aggregates. Surprisingly, the second protective mechanism enables the formation of larger aggregates from smaller ones that appear to be more toxic.

"The hope is that, by manipulating the protective mechanism inherent in cells, we can find a single entity -- a single drug-that would be useful for a variety of neurodegenerative diseases where protein aggregation leads to neurodegeneration," Kelly said.

High Blood Pressure, Smoking and Coffee Linked to Stroke

People who have high blood pressure, smoke cigarettes or consume large amounts of coffee have a greater likelihood of suffering a type of stroke known as an aneurysmal subarachnoid hemorrhage (SAH).

Using a population-based survey of risk factors for cardiovascular disease in 27,161 subjects, researchers at Tromsø University Hospital in Norway identified 26 cases of aneurysmal SAH in which risk factors were registered before the bleeding. Systolic and diastolic blood pressure, cigarette smoking habits, serum concentrations of lipoproteins, body mass index, and coffee consumption were analyzed.

The researchers found that the proportion of study participants who were smokers was significantly higher in patients with SAH (73.1 percent) than in the control group (41.3 percent). Drinking more than five cups of coffee per day was more common among patients (85 percent) than in the control group (59 percent). Mean (SD) systolic blood pressure was higher (154) than in the control group (136).

Current smokers were 4.5 times more likely to suffer a subarachnoid hemorrhage than those who never smoked, while drinkers of more than five cups of coffee a day were 3.86 times more likely to have such a stroke than those who drank less. Each increase of systolic blood pressure of 20 points brought forth a 2.46 times greater risk of a subarachnoid hemorrhage.

"Cigarette smoking, high coffee consumption and hypertension are significant independent risk factors for aneurysmal SAH," the researchers concluded. "A high coffee consumption may also predispose patients to aneurysmal SAH."

High Blood Pressure Smooths Out Emotions

High blood pressure may smooth out emotional high and lows, according to a study reported in the July/August issue of Psychosomatic Medicine

High blood pressure is already known to reduce sensitivity to pain.

Cynthia Pury, Ph.D., of Clemson University, recorded the blood pressure of 65 volunteers whose average age was 20 years and then showed them 32 photographs.

Half the pictures were intended to elicit a positive emotional response and half a negative response. After viewing each photograph, participants rated their reactions on scales of happy to unhappy and calm to excited.

The researchers linked a higher systolic (top number) blood pressure with more neutral and less extreme responses to the photographs. There was a similar but more modest effect for higher diastolic (bottom number) blood pressure.

Increases in blood pressure, Pury and her colleagues speculate, may help people cope with intense psychological stimulation by limiting emotional reactions. This may raise the threshold for stress reactions.

“If those with higher resting blood pressure perceive their environment as less threatening, they may stay in stressful situations for longer,” she says. “Likewise they may seek out greater levels of excitement.”

Drinking Outside of Meals May Significant Up Risk of Hypertension

Regularly drinking alcohol outside of meals may significantly increase the risk of high blood pressure, according to University of Buffalo researchers.

The findings were based on blood pressure readings and self-reported alcohol consumption patterns from a randomly selected sample of 2,609 white men and women between the ages of 35 and 80 who took part in the Western New York Health Study.

In a computer-assisted, in-person interview, participants provided data on their alcohol consumption during the past 30 days. Questions covered how often they drank during that time period, when they drank (weekdays versus weekends), how much they drank (drinks per day) and if they drank with meals, with snacks or without food. They also reported whether they drank mostly beer, wine or liquor.

Results confirmed findings of a previous study conducted in Italy by some of the same researchers and also showed for the first time that even light to moderate alcohol intake outside of meals puts drinkers at risk for hypertension.

Those drinking mostly outside of mealtimes were found to have a significant increase in risk of hypertension compared with either lifetime abstainers or those drinking mostly with food.

Not surprisingly, results confirmed that a high level of alcohol consumption -- defined as more than two drinks per day -- is associated with an increased risk of high blood pressure.

There was no difference in risk based on the type of alcohol consumed, or the gender of drinkers.

Results of the study appear in the December issue of the journal Hypertension. "These findings support the notion that in addition to amount, the way in which alcohol is consumed may have important implications for health and, in particular, for cardiovascular disease," said lead researcher Dr. Saverio Stranges.

"This is a novel finding with potentially important clinical implications," said Stranges. "It points out that drinking without food may counteract any benefit to the cardiovascular system associated with moderate alcohol consumption."

Many Primary Care Doctors Lack Concern Over Hypertension in High-Risk Patients

Nearly one-third of the primary care physicians in a study of patients with uncontrolled hypertension saw no need to change the treatment of patients with high or very high cardiovascular risk factors, according to Spanish researchers.

In their study of 1,413 patients with a mean age of just over 65 and uncontrolled hypertension, 34.5 percent were found to be at very high risk of cardiovascular disease and 29.4 percent at high risk.

Many also had a variety of other cardiovascular risk factors, with more than half of the patients overweight, more than half with high cholesterol, and four in ten with diabetes. In addition, two in ten had enlarged hearts and one-in-eight had microalbuminuria, an indicator of subclinical cardiovascular disease.

But even though the blood pressure of these patients was not controlled with treatment (pressure higher than 140/90 mmHg or higher than 130/80 mmHg in diabetics), nearly one-in-three of the primary care physicians felt no change in treatment was required. And just over half of the doctors asked patients to come in for a new control visit within 2-3 weeks.

“The results show that there is a significant lack of concern among primary care physicians about the importance of hypertension treatment in patients at high risk of cardiovascular disease,” said Dr. Antonio Coca of the Hypertension Unit at the Hospital Clínic of the University of Barcelona, Spain.

The findings were presented in New York City at the 21st Annual Scientific Meeting of the American Society of Hypertension.

No Link Between Coronary Bypass Surgery and Dementia

Fears about a link between coronary artery bypass surgery and dementia are unwarranted, according to Mayo Clinic researchers.

A possible link between bypass surgery and development of long-term cognitive decline has been a controversial medical issue.

In a study of residents of Rochester, Minn., bypass surgery was not a risk factor for dementia, according to lead researcher David Knopman, M.D., a Mayo Clinic neurologist.

According to Knopman, the study approached the issue in a unique way, noting that past studies have focused on those who have had the surgery without a suitable comparison group.

The Mayo Clinic study started with dementia patients and worked backward to find out whether these patients were more likely to have previously undergone bypass surgery. The researchers compared the dementia patients who had undergone bypass surgery to a non-demented control group.

In the five-year period studied, there were 564 dementia cases. Of these, 21 had undergone bypass surgery before developing dementia. In the control group, 23 people had undergone bypass surgery.

Knopman said his patients often raise the issue of a dementia-bypass surgery connection, noting that some claim to have begun experiencing memory problems after their surgery even though they didn’t have any obvious surgical complications. He said the study findings would allow him to tell concerned patients that their bypass surgery did not directly cause their memory issues. He acknowledged that the study does not discount the existence of short-term cognitive issues post-bypass surgery.

Physical Exertion for Men, Stress for Women Said Leading Causes of Sudden Heart Attack

Men and women are more likely to suffer a sudden heart attack for different reasons. For women, the common trigger is stress. For men, it's physical exertion.

University of Minnesota/Minneapolis Heart Institute Foundation reported these findings April 24 at an American Heart Association forum in Honolulu. They studied 122 men and women who had suffered out-of-hospital cardiac arrest.

Participants filled out a questionnaire that included detailed information about activities prior to their sudden cardiac arrests. They were also asked about psychological factors such as whether they had experienced a divorce, death of a loved one, family conflicts or other significant life events.

Women were more likely to report that they had experienced one or more psychologically stressful events rather than physical exertion prior to cardiac arrest. Of the 20 women in the study, 40 percent said they experienced psychological stressors and only 5 percent reported physical exertion. Forty percent of the men reported physical stress and 16 percent reported emotional stress before their cardiac arrest.

"Sudden cardiac arrest is a huge public health burden, and we still don't completely understand all inciting events. This study suggests that emotional triggers may be important in some cases," said Dr. Norman Ratliff, a cardiology fellow at the foundation and lead author of the study.

Ratliff said physical exertion might cause an increased level of adrenaline for men, while emotional stress may cause the same rise in women. Adrenaline is a stress hormone that can cause rapid heart beats.

Heavy Tea Drinking Helps Heart Attack Survivors Live Longer

The heart health benefits of tea have been reported widely, but now researchers claim that the amount of tea that heart survivors drink may have a lot to do with their survival afterwards.

As reported in the May 7th issue of Circulation: Journal of the American Heart Association, researchers found that heart attack survivors who reported being heavy tea drinkers had a 44 percent lower death rate in the 3.5 years following their heart attacks than non-tea drinkers. Moderate tea drinkers were found to have a 28 percent lower death rate than non-tea drinkers.

The observational study involved 1,900 individuals, both men and women mainly in their 60s, who were questioned an average of four days after suffering a heart attack and asked to report how much caffeinated tea they typically drank each week. The participants were then separated into three groups: non-drinkers, moderate tea drinkers (fewer than 14 cups per week) and heavy tea drinkers (14 or more cups per week).

"What was surprising was the magnitude of the association," said lead author Dr. Kenneth J. Mukamal of Beth Israel Deaconess Medical Center. "The heaviest tea drinkers had a significantly lower mortality rate than non tea-drinkers."

Mukamal said the protection stems from antioxidants known as flavonoids, which are plentiful in both black and green tea as well as certain fruits and vegetables. Besides preventing bad or LDL cholesterol from becoming oxidized and helping cause atherosclerosis, he said flavonoids possess an anti-clotting effect and improve the ability of the blood vessels to relax in cardiac patients.

"Among this particular group -- people mainly in their 60s who had suffered heart attacks -- tea consumption was not strongly related to lifestyle," he said, noting that the participants were similar in terms of education, income, exercise habits and smoking and drinking habits whether they drank a lot of tea or no tea at all.

Dealing with Often-Ignored Anemia Can Help Congestive Heart Failure Patients

Dealing with anemia can improve heart function and the ability to exercise in those suffering from congestive heart failure (CHF), according to a University of North Carolina cardiologist.

But first, according to Dr. Kirkwood F. Adams Jr., anemia has to shed its long-neglected image and be recognized as the contributor that it is to problems associated with CHF.

Although many physicians have questioned whether moderate anemia in CHF patients needs to be treated, Adams said recent studies have suggested that anemia adversely affects heart function and contributes to systemic changes, including impaired kidney function.

Speaking at an American Medical Association briefing June 6th in New York City, Adams said clinical trials have indicated that among hospitalized heart attack victims, depression of hemoglobin, even to a limited degree, was linked to increased mortality.

Adams said two recent small and preliminary studies have shown that hemoglobin increased in patients treated with erythropoietin and that those patients' ability to exercise improved. He said one study even suggested that the drug could cut time spent in the hospital.

Working with the drug company Amgen, Adams and colleagues have begun studying the effects of anemia on patients' physical activity and fatigue, how hormones affect anemia and quality-of-life issues.

"This focus on anemia is new, and it is definitely worth investigating because we believe it may make a difference with many congestive heart failure patients, and results so far have been encouraging," Adams said.

Second-Hand Smoke Raises Risk of Heart Disease for Non-Smokers

Greek researchers have concluded that non-smokers run a significant risk of developing heart problems from breathing second-hand smoke.

As reported in the journal BioMed Central Public Health, researchers at the University of Athens surveyed 2,000 non-smoking patients who were split into two groups. The first group included people who had shown up at hospitals suffering from a heart attack or acute angina. Those in the second group had no cardiovascular problems, but were being treated as outpatients for routine examinations or minor surgery.

Researchers asked participants whether they were currently exposed to cigarette smoke more than 30 minutes a day and how many years they had been exposed as an adult to second-hand smoke. The researchers analyzed the odds of developing heart disease for non-smokers who were exposed to cigarette smoke, while excluding the effects of other factors.

Even people who were exposed to cigarette smoke fewer than three times a week for more than 30 minutes on each occasion were found to have a 26 percent increased risk of developing acute heart disorders.

"The only safe way to protect non-smokers from exposure to cigarette smoke is to eliminate this health hazard from public places through legislation," concluded the researchers.

Glass of Red Wine Each Day May Drastically Cut Prostate Cancer Risk

Drinking a glass of red wine a day may cut the risk of prostate cancer in half, according to a study reported September 22 in the online edition of the International Journal of Cancer.

Researchers at Fred Hutchinson Cancer Research Center in Seattle also found that the protective effect of red wine appears to be strongest against the most aggressive forms of prostate cancer.

Study author Janet Stanford, Ph.D., and her colleagues found that men who consumed four or more four-ounce glasses of red wine per week reduced their risk of prostate cancer by 50 percent and had about a 60 percent lower incidence of the more aggressive types of prostate cancer.

The researchers found no significant positive or negative effects associated with the consumption of beer or hard liquor and no consistent risk reduction with white wine, which suggests a beneficial compound in red wine that other types of alcohol lack.

The key ingredient in red wine may be an antioxidant called resveratrol, which is abundant in the skins of red grapes but much less so in the skins of white grapes. The compound is also found in peanuts and raspberries and is available as a dietary supplement.

While the researchers found that the risk of prostate cancer decreased six percent for every glass of red wine consumed per week, Stanford said the law of diminishing returns comes into play when consumption increases beyond moderation.

"But for men who already are consuming alcohol, the results of this study suggest that modest consumption of red wine - four to eight 4-ounce drinks per week - is the level at which you might receive benefit,” said Stanford. “Clearly other studies show that more than that may have adverse effects on health."

Higher Radiation Doses Increase Prostate Cancer Survival

Prostate cancer patients receiving increased radiation doses delivered by highly conformal external beam radiation had a greater disease-free survival rate, according to a study presented October 5 at the American Society for Therapeutic Radiology and Oncology’s annual meeting in Atlanta.

For two decades, external beam radiation therapy has been one of the standard methods for treating prostate cancer. In the past, radiation oncologists have been limited in terms of the dose they could deliver to the affected area for fear of inducing serious bladder or rectal side effects.

In recent years, however, external radiation has become much more accurate, while the delivery of higher doses of radiation has become a real possibility.

Researchers examined whether a highly conformal technique employing the proton beam would allow the safe delivery of high radiation doses and whether the higher radiation doses would make a difference in the treatment of early stage prostate cancer.

The study involved 393 men with early stage prostate cancer who received either conventional dose or high-dose radiation therapy.

Regardless of the dosage, all of the patients were treated with the more accurate conformal radiation that included the use of a proton beam.

The five-year disease-free survival rate for those who received high-dose radiation therapy was promising as only 17 percent showed evidence of a recurrence of their cancer. Thirty-five percent of the patients who received the conventional dose experienced recurrence of cancer.

The level of rectal and bladder side effects was equally low – less than 2 percent experienced serious problems – whether the patients were treated with conventional dose or high-dose radiation.

“This study suggests that radiation oncologists can and should be more aggressive in their treatment of prostate cancer provided they have sophisticated dose delivery techniques such as proton beam at their disposal,” said study author Anthony Zietman, M.D., a radiation oncologist at Massachusetts General Hospital in Boston.

New Technique Makes Prostate Cancer More Susceptible to Treatment

Prostate cancer is resistant to most forms of chemotherapy and is notoriously difficult to treat, but British researchers have found a new way to make the disease succumb more readily to currently used treatments.

The key, according to the researchers, is blocking the action of a gene called IGF1R, resulting in prostate cancer cells becoming more sensitive to radiotherapy and certain kinds of chemotherapy.

The researchers believe the technique could improve survival prospects for patients with prostate cancer that has become resistant to treatment.

Previous studies have shown that IGF1R might be a good target for cancer treatment. The researchers wanted to see if inactivating the gene could improve the impact of existing treatments on prostate cancer.

Using a new technology called RNA interference (RNAi) to block IGF1R, the researchers found that switching off IGF1R in a selection of prostate cancer cells resistant to different treatments made the cells two times more sensitive to radiotherapy.

The technique made the cells significantly more sensitive to chemotherapy drugs that kill cells by damaging their DNA. In contrast, the technique did not enhance the effect of chemotherapy drugs that kill without causing DNA damage.

"These results suggest that IGF1R plays a role in the cell's response to DNA damage, and will tell doctors which type of chemotherapy drugs are likely to be enhanced by treatments targeting the gene, " said researcher Dr. Val Macaulay, of Cancer Research UK.

"This is the first study to show that silencing the IGF1R gene can improve the effectiveness of treatments for prostate cancer. As an oncologist I am excited at the possibility of conducting trials of IGF1R-inhibiting drugs with my own patients," added Macauley.

Noting that cancer cells have broken free of natural controls over their ability to divide, Robert Souhami, of Cancer Research UK, said many researchers are looking at ways to bring cancer cells back under control and to stop them dividing and spreading around the body.

"IGF1R sustains many types of cancer cell, so blocking the gene could prove a powerful new way of treating tumors,” said Souhami. This is early stage research, but holds great promise in the fight against not only prostate cancer but other forms of the disease."

Slipped Disk? Surgery or Physical Therapy? You Choose!

In people with slipped lumbar disks, comparisons of surgery and nonoperative therapy show that both have beneficial outcomes; however, surgery may be slightly superior, if the patient chooses this approach.

Introduction

Should you have surgery for your back problem? That's a common question asked around the world, as slipped disk (herniated lumbar disk) continues to be a common cause of low back pain. There are several causes of low back pain: muscle strain or spasm, sprains of ligaments (which attach bone to bone), joint problems, or a slipped disk. The most common cause is using your back muscles in activities you're not used to, like heavy lifting or yard work. But some patients have, indeed, a slipped disk, and the obvious question is whether surgery can help.

Lumbar diskectomy (removal of the disk) is one of the most common surgical procedures done in the USA for patients with back and leg symptoms, even though herniated disks are known to improve without surgery. The need for surgery has been assessed in patients in the so-called SPORT study (the Spine Patient Outcomes Research Trial). The results have been published in the Journal of the American Medical Association, and are summarized here.

What was done

The SPORT study enrolled patients between 2000 and 2004 at 13 spine clinics in 11 US states. They had to have an intervertebral disk herniation with persistent symptoms despite 6 months' continuous nonoperative treatment. Herniation was demonstrated by nerve-root pain, irritation, or loss of sensation, together with visualization on MRI. Patients who had had prior lumbar surgery were excluded, as were those with severe scoliosis, cauda equina syndrome (loss of bladder or bowel control), vertebral fractures, spine infection or tumors, and so on.

A total of 501 patients were randomized to one of two groups: surgical intervention, or nonoperative treatment. There were 743 patients who refused randomization, preferring to be able to chose surgery if they wanted to; these patients went onto form a separate part of the study - the Observational Cohort - which was reported separately1.

Surgery was standard open diskectomy under general or local anesthesia. Nonoperative treatment received 'usual care', which consisted of active physical therapy, counseling with home exercise instruction, and non-steroidal and opioid analgesics, as required.

Determination of successful treatment was based on improvements in pain and bodily function scores, and the American Academy of Orthopedic Surgeons' version of the Oswestry Disability Index (ODI). These were measured at baseline, 6 weeks, 3, 6, 12, and 24 months from enrollment.

What was found

There were 232 patients randomized to surgery, and 240 to nonoperative treatment. Their average age was 42, and 58% of them were men. Half of those assigned to receive surgery were operated on within 3 months of enrollment, while 30% of those assigned to nonoperative treatment also had surgery within the first 3 months.

The results were assessed using an 'intent-to-treat' analysis, thus making allowance for the relatively high percentage of crossover patients (50% from the surgical to the non-operative group, and 30% from the nonoperative to surgical group).

In an intent-to-treat analysis patients are analyzed for results according to the groups for which they were originally assigned. Why is this necessary? Patients who change groups are not typical of the patient population, and allowing them to change groups may counteract the intent behind the randomization process.) This was the case in the present study; there were statistically significant differences between the crossover patients and the rest of the patients.) The intent-to-treat analysis estimates so-called "use-effectiveness," the causal effect of selecting a treatment, rather than the "method-effectiveness", the causal effect of actually taking the treatment.

Both treatment groups showed considerable improvements in their pain and disability scores, their Oswestry index, and the other measurements made. Although all the differences between the groups favored the surgical patients, the differences were small and not statistically significant. Moreover, the differences between the two groups got smaller with time.

The analyses made on all the participants, according to their actual treatment (rather than the treatment they were randomly allocated) showed strong, statistically significant advantages for surgery at all times through two years.

The Observation Cohort findings

In this group of patients, 528 decided on surgery, while 191 elected nonoperative therapy. After 3 months, those who chose surgery had statistically-significant greater improvements in all scores over those on nonoperative therapy; the differences had narrowed somewhat by 2 years, but remained significant. In particular, self-reported changes in symptoms were greater for surgery. Both groups reported high levels of satisfaction for 'patient care'.

How to interpret these findings

The results of this study (or rather the two parts of this study) are not conclusive. In the randomized trial the number of patients who crossed over between treatments suggests that an intent-to-treat analysis was not really informative about comparative effectiveness of the two forms of treatment (surgery or nonoperative therapy). Both forms of treatment showed considerable improvement over 2 years, with surgery probably superior, but not significantly so. It may be tempting to take the 'as-treated' analysis of this study as showing the superiority of surgery, but this is less helpful than the 'intent-to-treat' in deciding which treatment the physician should recommend. In particular, it's unclear whether similar results would have been obtained if the patients had been restricted to their originally assigned treatments.

Again, the Observation Cohort result might appear to demonstrate that surgery offers the greatest benefits. However, the self-selection process invalidated proper comparison of the two treatments, as the patients in each group differed regarding age, work status, pay, pain perception, and self-assessment of their condition.

The only way a true comparison of surgery and nonoperative therapy for slipped lumbar disk can really be resolved is for a dummy-placebo study; in other words, patients would have to receive a sham surgical operation, a condition that would be unacceptable.

The best solution, therefore, according to the investigators and editorialists, is to allow the patient to select their therapy - surgery or nonoperative - according to their circumstances and their informed knowledge that both treatments offer a good chance of relief in the long term.

A New Screening Test for Alzheimer's

Summary

A new test, called SLUMS, has been developed, which is more efficient than the MMSE in diagnosing mild neurocognitive disorder.

Introduction

The routine test that physicians give to people they suspect may have Alzheimer's disease is the Mini-Mental State Examination (MMSE), also known as the Folstein test. It's been in widespread use since it was first published in 1975, and it's well accepted by experts. Apart from helping in diagnosis, it's used to follow the progress of the disease, especially in clinical trials of new treatments. However, the MMSE is not very good at identifying people with what is known as mild neurocognitive disorder (MNCD), especially in more educated patients. MNCD is also known as Mild Cognitive Impairment (MCI). In various studies, 12% to 28% of subjects progress to Alzheimer's disease within 2 to 4 years, at an average rate of 14 per year.

A more sensitive test that would disclose MNCD would help the physician identify patients on their first visit, so that they may start treatment as early as possible. Research physicians at St Louis University, led by Drs John Morley and Syed Tariq, decided to tackle this problem. They developed and tested a 30-point screening test, called The Saint Louis University Mental Status (SLUMS) examination, comparing its results with those from the MMSE in the same patients.

What was done

Geriatric hospitals in the Saint Louis area provided 705 volunteers for the study. At baseline a complete physical and mental status examination was done, with Diagnostic Statistical Manual of Mental Disorder criteria used to diagnose MCND or dementia. The participants were then given the MMSE and SLUMS examinations.

The MMSE is a series of questions and tests, each of which scores points if answered correctly. If every answer is correct, a maximum score of 30 points is possible. It covers orientation, memory, attention, calculation, language, writing, and drawing-copying skills1. The SLUMS is similar in format, but it supplements the MMSE with enhanced tasks in the attention, calculation, recall, digit span, clock- drawing, and immediate recall areas. The clock-drawing test assesses executive function, one of the earliest forms of cognition affected in MNCD. The test is reproduced at the first related link below.

The analyses of the results included evaluation of the sensitivity, specificity, and predictive values for various cut-off scores for the diagnosis of MCND and dementia, based on the results from the participants diagnosed with these conditions.2 The subjects were classified according to whether they had received high school education or not.

Results of the comparison

The average age of the participants was 75 years; 31% had less than a high school education, while 69% had a high school education or above. They were predominantly white males. There were 180 subjects (25.5%) with MCND, 82 (11.5%) with dementia, and 440 (63%) with normal brain function.

The optimal cut-off MMSE and SLUMS scores for the two groups of participants

Statistical analyses showed that the sensitivity and specificity were similar for both SLUMS and MMSE in detecting dementia, but the SLUMS appeared to be better in differentiating MNCD from normal cognitive function.

What SLUMS can do

Both SLUMS and MMSE can identify dementia, but SLUMS clearly has an advantage: it can help physicians diagnose MNCD on a first visit; using the MMSE for this requires follow-up screening to detect a decline in scores. One may hope that there will soon be effective treatment for MNCD, making its early diagnosis an important step.

In using the SLUMS, one can see the clear differentiation between the scores for both conditions:

The test is already in use at many Veterans Administration Hospitals. It seems a useful addition to the toolbox of primary care physicians who are trying to detect MNCD as early as possible. Let us hope there will soon be new medications availability that can help treat, or at least slow, this disorder.

Vitamin E - Not Too Little, Not Too Much

Summary

After years of controversy, new study results show clear benefits - decreased mortality, cardiovascular disease, cancer, and stroke - in Finnish men with the highest vitamin E serum levels.

Introduction

Many years ago, male rats fed vitamin E were found to show increased reproductive behavior, and the vitamin became popular in some areas as a sexual enhancement pill for men. It didn't produce any clinically-proven benefits in this direction, however, and interest waned. Then vitamin E became known as an antioxidant, and its use flourished again. People took large doses in the hopes of stemming atherosclerosis, dementia, and cancers.

In 1985 enrollment began in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study in Finland. The study ended in 1993, and in 1996 the investigators reported that beta-carotene supplements were associated with a greater risk of lung cancer in male smokers. This led many investigators to question the benefits of antioxidant supplements, including vitamin E. Although a few vitamin E supplementation trials have shown a reduction in the risk of chronic diseases, a recent analysis of 19 clinical trials suggested a small increase in all-cause death rate with high-dose supplementation.

Follow-up of the ATBC study is now completed, and some interesting results have just been published1. These have been discussed by an editorialist in the same journal, and we summarize his views here.

What's Known About Vitamin E?

Vitamin E is a required nutrient, and comprises 8 structurally related chemicals; the most important one is alpha-tocopherol, a fat-soluble antioxidant. Vitamin E deficiency in man is rare; in affected persons, who have a genetic defect in tocopherol metabolism, the main signs are neurological problems. Serum levels of alpha-tocopherol correlate poorly with dietary vitamin E intake, so that it's difficult to recommend the need for supplementation based on serum levels alone.

There are few signs of toxicity from overdosage, even at doses over 4000 IU. Prolonged prothrombin time, associated with reduced vitamin K levels and a bleeding tendency, is the main side effect at doses above 1600 IU/day. Thyroid hormones are sometimes decreased, and the immunological activity of white blood cells may be reduced.

The Latest ATBC Study Results

The new study report1 correlates outcomes after 19 years' follow-up with serum alpha-tocopherol levels at baseline. The men in the group with the highest serum levels had significantly lower numbers of total (i.e. all-cause) mortality, which included cardiovascular disease and cancer deaths. They also had significantly fewer deaths due to lung or prostate cancer, stroke, and respiratory disease.

These significant reductions in risk were seen as serum alpha-tocopherol levels rose from 9.1 mg/L to about 13 mg/L. The greatest reduction in mortality occurred at levels of 13 to 14 mg/L (30-33 mmol/L).

Making Use of These Findings

As Dr Traber says, "We now have a critical piece of information - that is, serum alpha-tocopherol concentrations of 13 - 14 mg/L optimally reduce mortality due to chronic disease. Now all we have to do is estimate how much alpha-tocopherol to consume to achieve that serum concentration". Easier said than done!

It's been shown that people with normal lipid levels who have a serum alpha-tocopherol level of 8.6 mg/L can increase this to 14.2 mg/L by taking 100 IU vitamin E daily (about 65 mg alpha-tocopherol) as a supplement. However, vitamin E supplements vary - e.g. synthetic or natural - and the amounts of alpha-tocopherol they contain can also vary.

The estimated average requirement for alpha-tocopherol proposed by the Food and Nutrition Board is 12 mg, or 18 IU of vitamin E. This is, in fact, the estimated dietary vitamin E intake in the ATBC study required to yield a serum level of 11.1 to 12.1 mg alpha-tocopherol. However, that study was done in Finnish male smokers. The average dietary consumption of 95% of men and women in the USA is below this level. To increase this intake to 15 mg daily, and thereby achieve relevant increased protection from chronic diseases, would probably require people to take supplements. That is, unless we can come to terms with greater consumption of vitamin E-rich foods: nuts, seeds, and vegetable oils, including olive, sunflower, or safflower oils.

Not taking Your Meds Can Be Dangerous to Your Health

Failure to take medications after a heart attack triples the likelihood of death in the following year; in diabetics, not taking medications increases hospitalization and mortality rates.


Summary
Introduction

No one (or almost no one) enjoys taking medications, yet most of us have to, at one time or another. Failure to take prescribed drugs can have serious consequences, as a series of reports in the Archive of Internal Medicine point out. We summarize here the findings in two of the most important ones - non-adherence to medication in patients after hospitalization for a heart attack, and in patients with diabetes.

Discontinuing medications after a heart attack

Denver researchers used data from patients enrolled at 19 hospitals in the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery (PREMIER) study. All patients with a verified myocardial infarction (heart attack) between January 2003 and June 2004 were registered. Data collected at baseline came from the medical records, an interview with the patient, and hospital discharge records.

The focus of this study was on three medications - aspirin, beta-blockers, and statins - that are well-recognized therapies to prevent a recurrence of heart attack. Medication use was obtained from the hospital records and telephone interviews done at 1, 6, and 12 months after discharge. Survival status at one year was ascertained using the Social Security Death Master file.

Out of 2500 patients enrolled, 70% were discharged from hospital with all three medications (aspirin, a beta-blocker, and a statin). Their average age was 60 years, 70% of them were male, and 80% were white. Over 1500 completed the one-month interview.

In the one-month reports it emerged that 66% continued taking all three medications, 12% discontinued all three, 4% discontinued two, and 18% discontinued taking one medication. Those who stopped all meds were more likely to be older, less well educated, and have more co-existing disorders, such as chronic lung disease.

The 1 in 8 patients who discontinued taking all 3 drugs at one month had a lower one-year survival rate compared with those who continued to take at least one of the 3 medications - 88.5% vs. 97.7%.

The analyses show that stopping medication after a heart attack is common (12% of patients after one month) and more than triples the risk of dying within one year. The findings are similar to those reported in another large published study. No solid information is offered regarding the causes or reasons for stopping medication, or the mechanism(s) for increased mortality.

Nonadherence to medication in diabetics

The same group of researchers used the Kaiser Permanente of Colorado diabetes registry to provide information on prescribed oral antidiabetic, high blood pressure, and statin medications, using their automated pharmacy records. Adherence to prescribed medication was obtained from filled prescription records; this allowed calculation of the actual medication purchases against the prescribed medication amounts. Adherence was expressed as the proportion of days covered (PDC), with a PDC calculated for each of the three categories of medications and for all three counted together.

As in the first study, baseline data was obtained from medical records during 2003. Hospitalizations and deaths were collected from January 2004 to April 2005. Data from 11,500 patients were analyzed. Their baseline age averaged 64, half were male, and most of them had co-existing conditions such as high blood pressure, high cholesterol, and coronary heart disease.

For the analysis, all patients were classified as "medication adherent" or "medication non-adherent", the latter depending on whether the PDC was below 80%. i.e. they were not taking their prescribed medications for at least 20% of the time.

It was found that 21% of the patients were non-adherent. In general, they were younger and had fewer co-existent conditions compared to adherent patients. During the follow-up period, non-adherent patients had higher HbA1c levels (i.e. their diabetes was less-well controlled), higher blood pressure, and higher LDL-cholesterol; these changes reflect omission of the three specific drug types studied.

Non-adherent patients were found to have a higher rate of hospitalization and all-cause mortality than adherent patients (23% vs. 19%, and 6% vs. 4%, respectively). When allowances were made for possible interfering factors, such as age, presence of high blood pressure, coronary heart disease, and so on, the rates of hospitalization and mortality were still significantly greater in the non-adherent patients. The results were similar when using the PDCs for the individual types of medications.

This study shows that non-adherence to three of their medications caused diabetics to have increased hospitalizations and mortality, compared with those who took their drugs as prescribed. The non-adherence rate was 21%, or one in five patients.

How to improve medication adherence

Another article in the Archives of Internal Medicine reports on the role of cost in non-adherence to prescribed medications in elderly and disabled Medicare recipients1. This is obviously a large factor, but not the only one, in non-compliance with the doctor's recommended therapy. An editorial in the same issue2 tries to suggest the likely causes and remedies for the problem that today costs the country an estimated $100 billion a year.

The patient is not the whole problem. The physician and economic factors each play considerable roles. Physicians often omit critical information when prescribing a new drug. They should improve their educational responsibilities to the patient, informing her/him of the purpose of the drug, the dosing schedule, possible adverse effects, and the risks associated with not taking the drug. The pharmacist can reinforce this information when providing the drug.

Having to take several drugs, or dosing several times daily, is another factor in non-compliance. Drug combinations are a step towards combating this. Going further, a polypill approach has been mooted, but has not been taken up yet. It would involve combining, say, generic forms of aspirin, an ACE inhibitor, and a statin in a single once-a-day pill. (See the first link below).

It may be possible to persuade patients to be non-adherent in a rational way. Thus physicians can concentrate on using especially beneficial drugs and cut back on the less beneficial ones. Or explain to the patient the relative importance of the drugs being taken, so that, if forced by economic circumstances to cut back, the patient will only eliminate the less relevant ones.

Particularly distressing is the switch some patients make from prescribed drugs to alternative therapies recommended by friends or unreliable information sources (e.g. the Internet). The proof of effectiveness demanded for prescription drugs should convince all but the most illogical of the benefits they offer over herbs and supplements. It all comes back to patient education - which is something we try to help provide in these pages.

Psychological Treatment Reduces Intensity of Lower Back Pain

Living with pain" is almost synonymous with "senior citizen." At least part of the reason so many older people suffer from unrelenting pain is that we are living longer and enduring more of the suffering that comes from aging bodies. This report looks at 10 years of research on using psychological treatments for relief.

Psychological interventions for chronic low back pain are effective, a new review of studies has found. Not only do these approaches improve psychological outcomes such as depression and health-related quality of life, they also reduce patients' experience of pain.

"Because this analysis was both more inclusive and more conservative than previous reviews, we have the best evidence to date that these interventions are helpful," said psychologist and review lead author Robert Kerns, Ph.D., of the VA Connecticut Healthcare System.

The review, part of a new article series, appears in the January issue of the journal Health Psychology. Each evidence-based review centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.

To evaluate the effects of psychological interventions on pain-related outcomes, Kerns and his team gathered data from 22 randomized trials published between 1982 and 2003. Trials were limited to adults with nonmalignant low back pain that had persisted for at least three months. However, most patients had been living with pain for much longer. The average duration was seven and a half years.

The studies were not limited to any one psychological approach. Included in the review were behavioral and cognitive-behavioral techniques; self-regulatory techniques such as hypnosis, biofeedback, and relaxation; and supportive counseling.

The review reports on 12 pain-related outcomes, including pain intensity, pain interference, depression, health care use, disability and health-related quality of life.

In the broadest analysis, psychological interventions - alone or as part of a multidisciplinary approach - proved to be superior to waiting lists or standard treatments on the entire range of pain-related outcomes.

When the researchers analyzed specific outcomes, they found that the largest and most consistent effect was a reduction in pain intensity.

This was somewhat surprising, Kerns said, because when psychologists first began developing interventions for chronic pain several decades ago, the goal was not to reduce pain but to help patients live with their pain more successfully.

"However, a growing body of knowledge suggests that these interventions are actually having a primary effect on people's experience of pain," he said.

The review found that psychological interventions also yielded improvements in health-related quality of life, work-related disability, interference of pain with daily living and depression.

Not all treatments were equally effective. Cognitive-behavioral and self-regulatory treatments seemed to yield the greatest effects, particularly when compared to waiting list control groups. Multidisciplinary approaches that included a psychological component also stood out on some measures, reducing pain interference and work-related disability when compared to other active treatments.

According to Dennis Turk, Ph.D., a professor of anesthesiology and pain research at the University of Washington in Seattle, patients with chronic pain sometimes fail to recognize the value of psychological treatments because they've been set up to expect a cure.

"Even the latest and greatest treatments don't cure people with chronic pain," he said. "Psychological interventions are not cures, but they do reduce pain and improve function and they are important components in the treatment of people with chronic pain."

Turk added that psychological interventions are also cost-effective when compared to other treatments for chronic low back pain -- a key finding, considering that estimates for treatment-related costs range from $20 billion to $80 billion a year in the United States.

"Surgery, opioids, nerve blocks, spinal cord stimulators, implantable drug delivery systems -- every one of those particular alternatives is much more expensive and has poorer or at best equal outcomes compared to rehabilitation programs that include psychological components," said Turk. "The paradox is that, despite data on the effectiveness of psychological interventions, insurers are less willing to pay for them."

Getting the word out that these treatments are effective and cost-effective is a challenge that psychologists will have to tackle head-on, Kerns said.

"We need to specifically target health care system administrators and third-party payers to try to engage them in a more productive dialogue about the importance of these interventions," he said. "We continue to have a huge, very costly problem in our society, but we have an intervention that is effective, and we need to do a better job of creating access to these services."

Acid Suppression Medication Linked With Increased Risk of Hip Fracture

Use of the drugs proton pump inhibitors (PPIs) for the treatment of acid-related diseases such as gastro esophageal reflux disease (GERD) is associated with a greater risk of hip fracture, according to a study in the December 27 issue of JAMA.

Potent acid suppressive medications such as PPIs have revolutionized the management of acid-related diseases. Millions of individuals have been using these medications on a continuous or long-term basis, according to background information in the article.

Some research has shown that PPI therapy may decrease insoluble calcium absorption or bone density in certain patients. These factors could increase the risk for hip fracture, which has a death rate during the first year after the fracture of 20 percent.

Among those who survive this period, 1 in 5 require nursing home care and often an emergency department visit, hospitalization, surgery, and rehabilitation, with huge health care costs.

Yu-Xiao Yang, M.D., M.S.C.E., of the University of Pennsylvania School of Medicine, Philadelphia, conducted a study to determine what effects PPI therapy has on bone metabolism and hip fracture risk in a large group representative of the general population.

The researchers analyzed data from the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study group consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years.

There were 13,556 hip fracture cases and 135,386 controls. The researchers found that more than 1 year of PPI therapy was associated with a 44 percent increased risk of hip fracture. The risk was 2.6 times higher among long-term users of high-dose PPI therapy. The strength of the association with hip fractures increased with both the dosage and the duration of PPI therapy.

“In summary, we observed that PPI therapy is associated with a significantly increased risk of hip fractures, with the highest risk seen among those receiving high-dose PPI therapy. Osteoporotic fractures are common among the elderly population, and they entail considerable morbidity and mortality.

"On the other hand, PPI therapy is widespread and may have an exaggerated effect among those at risk for osteoporosis. Thus, further studies are urgently needed to confirm our findings and clarify the underlying mechanism.

“At this point, physicians should be aware of this potential association when considering PPI therapy and should use the lowest effective dose for patients with appropriate indications. For elderly patients who require long-term and particularly high-dose PPI therapy, it may be prudent to reemphasize increased calcium intake, preferably from a dairy source, and co-ingestion of a meal when taking insoluble calcium supplements,”.

Senior Citizens May Want to Add Some Health Resolutions to Their 2007 List

Senior citizens, more health conscious than young people, for obvious reasons, may want to review the top resolutions for the new year that are suggested by the American Medical Association.

"The start of another new year provides us with an opportunity to reflect on the past 12 months and look ahead to changes we can make today to improve our health tomorrow," said AMA President-elect Ron Davis, M.D. "It is important that we develop healthy lifestyles and behaviors that we can carry with us throughout our lives."

The AMA is offering the resolutions below for 2007 and seniors may want to add some to their list.

● Don't Smoke: Avoid smoking -- the leading preventable cause of death -- as well as exposure to secondhand smoke (SHS). Released earlier this year, the U.S. Surgeon General reported that there is no risk-free level of exposure to SHS, and the California Environmental Protection Agency estimates that SHS kills 50,000 Americans each year.

● Eat Your Fruits and Vegetables: As recommend by the USDA Food Guide Pyramid, eat about two cups of fruit and two to three cups of vegetables daily to reduce your risk of developing heart disease, cancer, stroke, and high blood pressure.

● Cut Back on Salt: Limit your salt intake to one teaspoon per day (if you are 50 years of age or older, cut back to about half a teaspoon per day) to help lower blood pressure and decrease your chances of getting heart disease or having a stroke.

● Limit Fat in Your Diet: Eat a diet low in fat, saturated fat, and trans fats to reduce cholesterol levels and the risk of developing heart disease. Check Cholesterol: Have your blood cholesterol checked regularly by your doctor and keep your cholesterol level under 200 mg/dl to reduce your risk of developing heart disease.

● Reduce Amount of Soda You Drink: Per capita soft-drink consumption has increased by almost 500 percent over the past 50 years. Limit your consumption of regular soda pop and other sugar-sweetened drinks to help you avoid weight gain and obesity, and to also decrease tooth decay. Check Blood Pressure: Have your blood pressure checked regularly by your doctor to help reduce your chances of heart attack or stroke. If you have high blood pressure, make sure that you keep your blood pressure under 140/90.

● Get a Colonoscopy: If you are 50 years of age or older, ask your doctor about getting a colonoscopy to screen for colon cancer to improve your chances of early detection.

● Get a Mammogram: If you are a woman 40 years or older, get a mammogram every one to two years to help detect breast cancer early and if diagnosed, improve your chances for survival.

● Protect Your Skin from the Sun: Use sunblock (with an SPF of at least 30) or protective clothing when you're in sunlight for a prolonged period. If you frequently get a suntan or sunburn, have your doctor check your skin regularly to detect early signs of skin cancer.

"These resolutions are just a few of the things you can do to make positive, healthy lifestyle changes. In 2007, continue to look to the AMA for a wide range of health information and continue to turn to your physician for the highest quality of care for you and your family,"

Seniors at Risk during Flu Season

Kreger sites statistics which note that persons over the age of 65 account for more than 90 percent of the approximately 35,000 flu-related deaths in the United States each year. That’s an alarmingly high number. Most often, however, seniors don’t die from the flu directly but rather complications involving other existing medical disorders that are caused by the influenza virus.

The author notes that most doctors recommend that seniors get their flu shots as early in the season as possible, around October or November, shortly after the shots become available.


Late administering of the shot may still be beneficial, she notes, but “the sooner, the better” is a good rule to follow.

Avoiding others who are currently sick with the flu is, of course, one of the best ways not to catch it. Remember, the flu is spread by droplets excreted during coughing or sneezing, so the closer one is to an infected person, the greater the chance of catching the flu. Doctors also note that the flu virus can remain in tact on surfaces for up to eight hours, so be careful what you touch.

Constant washing of hands, Kreger notes, is still the best way to avoid contracting influenza. If you think you’ve touched an infected area, keep your hands away from your eyes, nose, or mouth until you can wash them or carry hand sanitizer with you.

For seniors, eating balanced meals is also essential during the cold and flu season as an improper diet can lower the effectiveness of the immune system, making individuals with poor diets more susceptible to illness.

Weight Loss Cuts Prostate Cancer Risk

Prostate cancer is the most common cancer (except for skin cancer) in U.S. men, becoming more common with age.

This study is the first to probe links between a man's adult weight change and prostate cancer risk.

In 1992, Rodriguez and colleagues asked nearly 70,000 U.S. men about their current weight and their weight 10 years earlier.

The researchers then tracked new prostate cancer cases among the men from 1992 to 2003.

Those who reported losing at least 11 pounds from 1982 to 1992 were about 40% less likely to develop aggressive (but nonmetastatic) prostate cancer between 1992 and 2003 than those with little weight change in the 1982-1992 time period.

Weight and Prostate Cancer

"Our study linking obesity to aggressive prostate cancer adds to increasing evidence of the importance of maintaining a healthy weight throughout life," Rodriguez says in an American Cancer Society news release.

"Although our study suggests that weight loss may lower the risk of aggressive prostate cancer, given the difficulty of losing weight, emphasis should be put on the importance of avoiding weight gain to reduce the risk of prostate cancer," she says.

Prostate Cancer Study

Most of the men who took part in the study were 55-74 years old in 1992. None had had cancer other than nonmelanoma skin cancer

The men reported their height and weight. Using those figures, the researchers calculated the men's BMI (body mass index), an indication of appropriate weight.

Nearly two-thirds of the men were overweight or obese in 1992. Thirty-six percent had normal BMI, 50% were overweight, and 14% were obese.

In 1992, most of the men -- 44% -- reported little weight change in the past decade, gaining or losing 5 pounds or fewer.

Twenty-one percent said they had lost more than 5 pounds, and 35% said they had gained 5 or more pounds between 1982 and 1992.

Tracking Prostate Cancer

By the middle of 2003, 5,252 men reported being diagnosed with prostate cancer. Most cases weren't aggressive.

Men who had lost weight between 1982 and 1992 were less likely to have been diagnosed with aggressive prostate cancer, the study shows.

The results held when the researchers took other factors into account -- including age, race, family history of prostate cancer, smoking, diabetes, and physical activity.

The researchers' conclusion: "Men who lose weight may reduce their risk of prostate cancer."

Study's Limits

The men reported their own weight and height; those measurements weren't confirmed.

The data don't show which men had been overweight or obese since childhood. So the lifelong influence of obesity on prostate cancer risk isn't clear from this study.

The researchers didn't assign anyone to lose weight, so this was an observational study rather than a direct test of weight loss for prostate cancer prevention.

The study appears online in Cancer Epidemiology Biomarkers & Prevention.

Men who want to lose weight should consult their doctor for advice.