CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease

Health Report:


CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease

Sweetened Beverages and Coronary Artery Disease



"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Updated: 03/22/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


CABG SURGERY vs. PCI IN DIABETICS WITH CORONARY ARTERY DISEASE

Two weeks ago, I reported on a prospective randomized clinical trial that compared coronary artery bypass surgery (CABG) with coronary artery angioplasty and stent placement (percutaneous coronary intervention, or PCI). I noted that, based upon the early results of this clinical study, the jury may still be out regarding which of these two treatment approaches to coronary artery narrowing (stenosis) offers the best risk-to-benefit equation for most patients. Now, a new report, just published in The Lancet, has analyzed the results of 10 different prospective randomized clinical research trials comparing CABG with PCI in the treatment of coronary artery disease affecting multiple coronary arteries.

Altogether, the 10 clinical trials evaluated in this report included 7,812 patient volunteers. After an average of 6 years of clinical follow-up, 575 of the 3,889 (15 percent) patients who underwent CABG died, while 628 of the 3,923 (16 percent) patients who underwent PCI died. Therefore, overall, there was no difference in survival between the two treatment groups within 6 years of coronary artery intervention. However, when the researchers analyzed certain groups of patients undergoing coronary artery interventions, they discovered that diabetic patients appeared to do much better following CABG, rather than PCI. Among the patients with diabetes, survival at 6 years after treatment was 30 percent greater among those diabetic patients who underwent CABG when compared to the diabetic patients who underwent PCI. Similarly, patients over the age of 65 also appeared to do better with CABG. Among patients over the age of 65, survival at 6 years was 18 percent better in the CABG group when compared to the PCI group. For all other patients, however, there was no statistically significant difference in survival at 6 years between those patients who underwent PCI and those who underwent the far more invasive CABG surgery.

Approximately 1.5 million coronary artery interventions (CABG and PCI) are performed in the United States each year, and an estimated 25 percent of these patients have diabetes. So, a significant number of patients undergoing CABG and PCI also have diabetes. The results of this analysis are in keeping with the findings of previous studies showing that the coronary arteries of diabetic patients are more likely than those of non-diabetic patients to narrow again following PCI using balloon angioplasty, with or without the insertion of bare metal stents. However, recent advances in the development of drug-eluting stents and newer anti-clotting drugs have shown considerable promise in diabetic patients undergoing PCI with stent placement (among the 10 clinical studies included in this analysis, all patients receiving PCI underwent balloon angioplasty with or without bare metal stent placement, and no drug-eluting stents were utilized). Fortunately, there are several ongoing prospective randomized clinical research trials that will, hopefully, shed more light on the coronary artery restenosis rate in diabetic patients using the newer drug-eluting stents and glycoprotein IIb/IIIa inhibiting drugs. Unfortunately, we will have to await the publication of the findings of these ongoing clinical trials before PCI can truly be declared equal to CABG in diabetic patients. Therefore, at the present time, patients with diabetes, and especially diabetic patients with more advanced multi-vessel coronary artery disease (as well as diabetic patients with abnormal function of the primary pumping chamber of the heart, the left ventricle) are more likely to be advised to undergo CABG instead of PCI; although an increasing number of favorable-risk diabetic patients with complicated coronary artery disease are now being offered PCI with the newer drug-eluting stents and anti-clotting drugs.

As I concluded 2 weeks ago, the ongoing improvements in minimally-invasive PCI have definitely narrowed the gap in clinical outcomes between PCI and CABG over the past 10 to 15 years, and it is no longer clear that CABG (which is much more invasive than PCI, and more likely to cause stroke than PCI) offers any significant survival benefit over PCI, although CABG does appear to still provide a longer duration of improvement in blood flow to the heart than PCI (however, PCI can often be repeated, when necessary), and CABG may still be more appropriate for patients with more advanced cases of multi-vessel coronary artery disease.

Stay tuned, as I will continue to track the results of this very important area of clinical research, and I will keep readers updated as the ongoing “CABG vs. PCI” clinical research trials begin to report their results.



SWEETENED BEVERAGES AND CORONARY ARTERY DISEASE

We all know that we are in the midst of an epidemic of obesity in this country. Not only are adults heavier than ever before, but the incidence of overweight and obesity among our children has skyrocketed, and with this rising incidence of childhood and adolescent obesity, the incidence of other obesity-related diseases has also increased.

Multiple prior studies have linked the regular consumption of sweetened sodas and juices with excessive weight gain in both children and adults, and with a rising incidence of diabetes among both the young and old. Now, a new Harvard University clinical study of female nurses, just published in the American Journal of Clinical Nutrition, suggests that the regular consumption of sugary beverages may also significantly increase the risk of coronary artery disease as well.

In this prospective clinical study, nearly 90,000 women (ages 34 to 59) participating in the enormous Nurses’ Health Study were followed from 1980 through 2004. None of these women had any clinical signs or history of heart disease, stroke, or diabetes when they entered into this clinical research study. All of these women completed repeated and detailed dietary surveys during the 24-year follow-up period in this study.

Among these 88,520 female nurses, 3,105 developed coronary artery disease during the 24-year follow-up period. When the researchers analyzed intake levels of sugary drinks, they discovered that the increasing consumption of sweetened beverages was associated with an increased risk of coronary artery disease. When compared to women who consumed less than one sugary drink per month, consuming one sugary drink per day increased the relative risk of coronary artery disease by 23 percent, while the consumption of 2 or more sugary drinks per day increased the relative risk of developing coronary artery disease by 35 percent. When the researchers then accounted for differences in body weight, overall dietary caloric intake, and the presence or absence of diabetes among these women volunteers, the risk of coronary artery disease associated with the consumption of sweetened beverages was diminished somewhat, but still remained significant. At the same time, artificially sweetened beverages were not associated, at all, with coronary artery disease risk.

In summary, this enormous and ongoing clinical research trial, with nearly 90,000 women participating, found that, over a 24-year observation period, increasing levels of sugary drink consumption were associated with increasing levels of risk for coronary artery disease. At the same time, beverages that were sweetened with non-caloric artificial sweeteners appeared to carry no associated risk of coronary artery disease. So, next time you reach for a bottle of sugar- or fructose-sweetened juice or soda pop, give it another thought before you pop the top!

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

Send your feedback to Dr. Wascher at: rwascher@doctorwascher.net

Dr. Wascher's Biography


Links to Other Health & Wellness Sites


http://doctorwascher.com


Copyright 2009

Robert A. Wascher, MD, FACS

All rights reserved


Dr. Wascher's Archives:

3-15-2009: Depression, Stress, Anger & Heart Disease
3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children
3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children
2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Dr. Wascher's Home Page

Depression, Stress, Anger & Heart Disease

Health Report:

Depression, Stress, Anger & Heart Disease


"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Updated: 03/15/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.



DEPRESSION, STRESS, ANGER & HEART DISEASE

According to recent surveys, about 75 percent of Americans are worried, depressed or angry about the economy. All of us, it seems, know someone who has lost their job recently, and many of us worry that we might be next. Sleep is hard to come by for many of us during these turbulent and uncertain times, and as I have discussed in recent articles on this website, chronic sleep deprivation, itself, has previously been linked to higher mortality rates in some clinical studies.

A number of illnesses have previously been linked to periods of prolonged stress, and particularly those situations that leave people feeling “helpless and hopeless” with respect to the events that are causing them to feel stressed. Prolonged periods of severe stress tend to disrupt the normal function of critical systems in our bodies, including the brain, the GI tract, the immune system, the reproductive system, and the cardiovascular system. Two important and timely news studies, just published in the Journal of the American College of Cardiology, further add to our understanding of the potentially adverse impact of chronic stress on our health.

In the first study, from Harvard University, more than 63,000 women participating in the enormous prospective Nurses’ Health Study were evaluated. All of these women underwent extensive psychological and physical evaluations in 1992, 1996, and again in 2000. None of these women had any clinical history of coronary artery disease or stroke at the time that they underwent their initial evaluation in 1992. The incidence of sudden cardiac death, heart attack, or death due to heart attack was then assessed in this huge cohort of adult women during the 8-year monitoring period. Additionally, the incidence of clinical depression (as measured by standardized mental health questionnaires and the use of antidepressant medications) was evaluated and analyzed in these patient volunteers.

The presence of clinical depression was found to significantly correlate with the risk of cardiac events in this study, even after controlling for other preexisting coronary artery disease risk factors in these 63,469 women. The presence of clinical depression was associated with a 49 percent increase in the risk of fatal heart attack (myocardial infarction) due to coronary artery disease. Sudden cardiac death was also much more common among the depressed women in this gigantic clinical study, and especially among the women who were taking antidepressant medications. In fact, the women who were taking antidepressant medications experienced more than twice the risk of sudden cardiac death (2.33-fold increased risk) when compared to the women without any history of depression or antidepressant use!

Therefore, clinical indicators of depression, including depression confirmed by standardized mental health screening questionnaires or the use of antidepressant medications, were associated with a strikingly increased risk of coronary artery disease, heart attack, fatal heart attack, and sudden cardiac death. If you believe that you are depressed (or if family or friends believe that you may be depressed), please see your physician or a mental health expert, as chronic depression can, indeed, be a matter of life or death.


The second, and related, research study that I would like to discuss today focuses more on the role of anger and hostility in coronary artery disease risk. In the 1970s and 1980s, a great deal of “pop psychology” was given over to classifying personalities into various general types. Highly driven people, who tend to be impatient, easily-angered, and prone to hostile responses, were categorized as having “Type A” personalities, while their calmer and less driven counterparts were considered to have “Type B” personalities. Type A people, it was said, are more likely to engage in risky behaviors that increased the likelihood of premature death due to accidents and cardiovascular disease. Some older research has even suggested that having a Type A personality might be directly associated with a higher risk of cardiovascular disease as a result of chronic anger and hostility, rather than indirectly from engaging in lifestyle behaviors known to increase the risk of heart disease.

In this second clinical study, researchers in London comprehensively reviewed 25 previously published clinical studies of coronary artery disease risk in healthy populations, as well as another 19 studies of patient volunteers with existing coronary artery disease. All of these studies included assessments of personality profiles among the patient volunteers who participated in these clinical research trials.

Among the studies of previously healthy volunteers, those patients who scored highly on psychological assessment tools in terms of anger and hostility were nearly 20 percent more likely to develop evidence of new coronary artery disease (including heart attack) when compared to the patients who had very low hostility and anger scores. Among the patients who were known to already have coronary artery disease at the time that they enrolled in these studies, there was a 24 percent greater likelihood of serious complications associated with coronary artery disease among the angry and hostile patients, including death due to heart attack, than was observed among the heart disease patients who were not predisposed to anger and hostility. Interestingly, as has been observed in previous research studies, the incidence of coronary artery disease events, including heart attack and death due to heart attack, appeared to be significantly higher among angry and hostile men than was observed among angry and hostile women, particularly among the study volunteers who had no prior history of coronary artery disease at the time that they enrolled in these studies.

In summary, this comprehensive review of previously published data appears to confirm the findings of earlier studies that chronic anger and hostility appear to be associated with an increased risk of coronary artery disease and heart attacks, even when other preexisting coronary artery disease risk factors are controlled for. Furthermore, this analysis suggests that having an angry and hostile predisposition is probably more dangerous for men than for women, although both genders probably experience an increased risk of heart disease if they are chronically angry or hostile. Finally, angry and hostile people who develop coronary heart disease appear to have a worse prognosis when compared with mellower folks who also have the equivalent extent of heart disease.

As with the link between chronic depression and heart disease, chronic feelings of anger and hostility appear to increase one’s risk of developing heart disease too. If you believe that you are susceptible to depression, or to regular or frequent feelings of anger and hostility towards others (or towards yourself, for that matter), then you owe it to yourself, and to those who care about you, to seek help. These mental health and personality difficulties are often extremely difficult to resolve by yourself, no matter how much insight and motivation you might already have. If you struggle with any of these issues, or if other people who know you and care about you have suggested that you have problems in these areas, then please seek help now.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

Send your feedback to Dr. Wascher at: rwascher@doctorwascher.net


Dr. Wascher's Biography


Links to Other Health & Wellness Sites


http://doctorwascher.com


Copyright 2009

Robert A. Wascher, MD, FACS

All rights reserved


Dr. Wascher's Archives:

3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children
3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children
2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer


Dr. Wascher's Home Page

Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children

Health Report:


Coronary Artery Disease: CABG vs. Stents?


Swimming Lessons & Drowning Risk in Children



"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Updated: 03/8/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


CORONARY ARTERY DISEASE: CABG vs. STENTS?

The debate over the optimal treatment of coronary artery diseases continues, even among top heart disease experts. Much of the clinical research thus far has suggested that coronary artery stents work about as well as the far more invasive coronary artery bypass grafting (CABG) surgery does, at least in the short term, but that the benefits of CABG surgery tend to last longer than coronary artery stents. Of course, the risks associated with CABG surgery, especially in the early period after surgery, tend to be higher than for stent placement (although patients undergoing CABG surgery also tend to have more advanced coronary artery disease than patients who are typically selected for less invasive coronary artery stent placement procedures).

A new prospective, randomized clinical research trial, just published in the New England Journal of Medicine, further clarifies important differences in outcomes among patients undergoing coronary artery stent placement versus CABG surgery. In this impressive interventional study, 1,800 patients with coronary artery disease involving either all 3 major coronary arteries or the dominant “left main” coronary artery were randomized to undergo either CABG surgery or coronary artery stent placement (also known as percutaneous coronary intervention, or PCI). Historically, patients with these patterns of advanced coronary artery disease have been advised to undergo CABG surgery instead of PCI, due to the improved durability of CABG, over time, when compared to PCI. However, given the minimally invasive nature of coronary artery stent placement, when compared to CABG surgery, both cardiologists and patients have a strong interest in learning whether or not more advanced cases of coronary artery disease can be effectively treat with PCI instead of CABG surgery.

Following CABG or PCI, the 1,800 patient volunteers were observed for an average period of one year, and the incidence of death (from any cause), heart attack, stroke, or the need for additional coronary artery disease interventions, was tracked in both patient groups.

The results of this study largely confirmed earlier clinical studies that have favored CABG surgery over PCI in patients with diseased left main coronary arteries, and in patients with 3-vessel coronary artery disease. The incidence of major acute coronary artery events was significantly higher in the PCI group when compared to the CABG surgery group (18 percent in the PCI group versus 12 percent in the CABG surgery group). Much of this observed difference in recurrent coronary artery events between the two patient groups appeared to derive from the two-fold increase in the need for repeat coronary artery interventions in the PCI patient group when compared to the CABG surgery patients. Nearly 14 percent of the PCI patients required a repeat coronary artery intervention within 12 months of their initial PCI procedure, while only 6 percent of the CABG surgery patients required another coronary artery intervention within a year of their initial surgery. At the same time, it is important to note that, at 12 months following initial coronary artery intervention, the death rate and the heart attack (myocardial infarction) rate was essentially equivalent between the two patient groups, and the stroke rate was actually higher in the CABG surgery group (2 percent in the CABG surgery group versus 0.6 percent in the PCI group).

The authors of this study concluded that, after one year of follow-up, CABG surgery was superior to coronary artery stent placement (PCI), as the patients who underwent PCI were twice as likely to require subsequent coronary artery interventions when compared to the patients who had undergone CABG surgery. However, in my view, the results of this study, as published are somewhat more equivocal, especially from a patient’s perspective. Although the duration of follow-up in this study (one year) was very brief, this study revealed that the overall death rate was essentially equivalent with either intervention, and many patients in the PCI group were spared the need for major open-heart surgery (and its attendant higher risk of stroke). Ultimately, it will require longer follow-up of this cohort of patients, in my view, to prove the claimed superiority of CABG surgery over PCI for 3-vessel or left main coronary artery disease. Based upon previous research studies, one would anticipate that, over a period of 10 to 15 years, the patients who underwent CABG surgery in this study are likely to experience fewer adverse cardiovascular events than the patients who underwent PCI. As other recent clinical studies have shown, though, the differences in important clinical outcomes during the first few years following either CABG surgery or PCI may be far less than what older studies have suggested, and this narrowing of differences in early outcomes may reflect recent advances in PCI. For now, in my view, the debate regarding the inherent superiority of CABG over PCI for certain groups of patients with coronary artery disease has not yet been fully resolved by this important new study, and only long-term follow-up of this study’s patient volunteers is likely to definitively decide this ongoing debate.


SWIMMING LESSONS & DROWNING RISK IN CHILDREN

My wife, it can be revealed, never learned to swim, despite spending most of her life living in beach communities. As a form of parental compensation for my wife’s lack of comfort in an aquatic environment, our two young children have been charged with learning to swim from a very early age. Of course, this makes perfect sense to me as well, given that we continue to live near the beach. However, due to the not very infrequent tragic stories of young children drowning in family pools, I have sometimes worried that increasing our young children’s comfort levels in the water could expose them to an increased risk of a pool-related accidents, due to overconfidence on their part. I was, therefore, quite relieved to find a newly published research study on this very topic, which appears in the current volume of the Archives of Pediatric and Adolescent Medicine.

In this retrospective case-control study, the authors reviewed cases of drowning deaths occurring in children and adolescents between the ages of 1 and 19 years in the states of Maryland, North Carolina, Florida, California, Texas, and New York. The researchers then interviewed a sample of 88 families of children and teens, from these same states, who had died in drowning accidents. A control group of 213 families who had not experienced the tragic loss of a child was also interviewed. The results and conclusions of this innovative clinical study were rather striking (and personally reassuring to me).

Of the 61 families who lost a child between the ages of 1 and 4 years to drowning, only 3 percent had enrolled their lost child in swimming lessons, while 26 percent of the control group families with children in this same age range had enrolled their toddlers in formal swimming lessons. Among the 27 families that had lost children between the ages of 5 and 19 years to drowning accidents, 27 percent had enrolled their deceased children in formal swimming lessons, compared with 53 percent of the same-aged children in the 79 control group families. (While these results suggest that formal swimming instruction in children aged 5 years or older decreases the risk of accidental drowning, the results in this age group were not statistically significant, unlike the results observed for the younger children.) At the same time, when the researchers looked at unstructured or otherwise informal swimming instruction as a risk factor for accidental drowning, they found absolutely no association between informal instruction and drowning rates in children and adolescents.

The results of this retrospective case-control study identified a whopping 88 percent reduction in the risk of accidental drowning among 1 to 4 year-old children who had undergone formal swimming instruction, when compared to same-age toddlers who had either never undergone formal instruction or who had undergone only informal, unstructured swimming instruction. While the retrospective case-control methodology used for this study is not as powerful as would be observed in a prospective clinical research trial, this study’s findings do reassure me that there is most likely some significant benefit associated with formal swimming lessons in younger children. Selection biases, as well as other potential sources of bias, are difficult to eliminate in these types of clinical studies, and so the absolute benefit of swimming lessons is likely to be less than the 88 percent level reported by this retrospective study. However, when one is considering even potentially modest reductions in the risk of losing one’s child to accidental drowning, there is no such thing as a trivial level of risk reduction, in my view. So, our young children will definitely be continuing with their swimming lessons at our friendly neighborhood YMCA.


Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California


Send your feedback to Dr. Wascher at: rwascher@doctorwascher.net

Dr. Wascher's Biography


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Copyright 2009

Robert A. Wascher, MD, FACS

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Dr. Wascher's Archives:

3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children
2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer


Dr. Wascher's Home Page

Health Report:


Aspirin & Colorectal Cancer Prevention


Fish Oil & Respiratory Infections in Children



"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS



Last Updated: 03/1/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.


ASPIRIN & COLORECTAL CANCER PREVENTION

Non-steroidal anti-inflammatory drugs, or NSAIDs, have previously been shown to reduce the incidence of polyps and cancers of the colon and rectum. This class of drugs includes the well-known medications ibuprofen, naproxen, sulindac, indomethacin, Celebrex, Vioxx, and aspirin, among others. However, enthusiasm for using NSAIDs as colorectal polyp and cancer prevention drugs has cooled significantly after several large prospective clinical research studies linked several of these drugs, including Celebrex and the subsequently discontinued Vioxx, to an increased risk of heart disease. Fortunately, aspirin, which is a weak NSAID, is still thought to protect the heart against coronary artery disease. However, previous clinical research studies have suggested that daily aspirin use only provides very modest protection, if any, against polyps and cancers of the colon and rectum. Now, a new study, just published in the Journal of the National Cancer Institute, comprehensively reviews the results of 4 prospective clinical colorectal cancer prevention research studies, and suggests that the humble aspirin pill may, indeed, offer significant protection against the type of colorectal polyps (adenomas) that are believed to give rise to virtually all colorectal cancers.

This new study performed a complex statistical evaluation, called a meta-analysis, of 4 prospective, randomized, placebo-controlled colorectal cancer prevention trials that, together, included almost 3,000 patient volunteers. The average age of these patient volunteers was 58 years, and average patient follow-up of these nearly 3,000 patients was about 3 years. Colonoscopy was performed on about 2,700 of these patients during the course of these 4 studies. Among the patients who were secretly randomized to receive placebo (sugar) pills, 37 percent were found to develop polyps (adenomas) of the colon or rectum during the course of these clinical studies. Among the patients who were secretly assigned an aspirin pill each day, 33 percent were found to harbor colorectal adenomas while being observed. Advanced precancerous adenomas were also identified in 12 percent of the patients in the placebo group, while 9 percent of the patients in the daily aspirin group were found to have advanced premalignant adenomas.

After analyzing the data, the authors of this study determined that any dose of aspirin between 81 mg and 325 mg per day was associated with a 17 percent reduction in the relative risk of colorectal adenomas, and an absolute reduction in the risk of adenomas of about 7 percent. Moreover, a daily aspirin pill was associated with a 28 percent relative reduction in the risk of developing advanced high-risk adenomas (i.e., the type of colon or rectal polyp that is most likely to subsequently progress to become a cancer).

In summary, based upon data from 4 different prospective, randomized, placebo-controlled clinical colorectal cancer prevention research studies, a daily baby aspirin, or a daily 325 mg “regular” aspirin pill, significantly reduced the incidence of colon and rectal polyps, and especially the high-risk forms of adenomatous polyps that are more likely to progress to colon and rectal cancers.

If you are not already taking aspirin, you should first consult with your physician before beginning aspirin therapy. Aspirin, like all NSAIDs, can cause ulcerations in the GI tract, as well as kidney damage, in susceptible patients. If there are no contraindications to taking aspirin in your case, however, then you may be able to reduce not only your risk of cardiovascular disease, but also your risk of colorectal cancer as well, by taking a daily aspirin tablet.



FISH OIL & RESPIRATORY INFECTIONS IN CHILDREN

The available research evidence suggests that a diet rich in coldwater fish may significantly reduce the risk of heart disease. There is also additional research suggesting that oil from coldwater fish might also improve immune system function, particularly in young children. A newly published study in the Journal of Pediatrics now suggests that fish oil supplements may actually reduce the risk of common acute illnesses in school children.

In this study, nearly 200 schoolchildren between the ages of 9 and 12 years were randomized to receive either a placebo (sugar) pill or a fish oil supplement pill 5 days per week. The children were all monitored for 6 months, and logs were kept of all illnesses that occurred in these kids.

At the end of the study, the researchers determined that the kids who were randomized to receive the fish oil supplements had a significantly lower incidence of acute childhood illnesses, and respiratory infections in particular, when compared to the children who had been randomized to receive placebo pills instead. Respiratory infections, when they occurred, also appeared to resolve more quickly in the group of children who had received fish oil supplements, when compared to the kids in the placebo group. The researchers also measured the levels of several different immune-system-related substances in the blood of these patient volunteers, including TGF-beta protein, a substance which is known to impair the function of immune system cells. Among the children in the fish oil supplement group, TGF-beta levels in the blood were actually significantly lower than was observed among the children in the placebo group. The researchers, therefore, concluded that fish oil supplements appeared to decrease both the frequency and duration of acute illnesses in schoolchildren, and respiratory illnesses in particular. Immune-suppressing TGF-beta blood levels were also lower among the children who were randomized to receive fish oil supplements.

Before considering fish oil supplements for your child, please make sure to consult with your pediatrician first. Large doses of fish oil can expose children to potentially toxic doses of heavy metals and pesticides, and can also excessively thin the blood.
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California


Send your feedback to Dr. Wascher at: rwascher@doctorwascher.net


Dr. Wascher's Biography


Links to Other Health & Wellness Sites


http://doctorwascher.com



Copyright 2009

Robert A. Wascher, MD, FACS

All rights reserved


Dr. Wascher's Archives:

2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer


Dr. Wascher's Home Page