Vitamin D & Falls in the Elderly

Health Report:

Vitamin D & Falls in the Elderly

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

By, Robert A. Wascher, MD, FACS

Updated: 10/11/2009

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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.

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Vitamin D & Falls in the Elderly

Regular readers of this column are already aware of the intense research underway regarding the potential health benefits of Vitamin D beyond its long understood role in calcium absorption and bone health. A growing body of research suggests important potential roles for Vitamin D in maintaining good cardiovascular health and in the prevention of some types of cancer. More recently, clinical research has also suggested that Vitamin D may also help to directly improve muscle strength.

Falls among the elderly are a major public health problem, and are the most common cause of injury-related death in persons older than 65 years of age. It has been estimated that 30 percent of people over the age of 65 sustain falls every year, while 45 to 60 percent of people aged 80 years or greater experience significant falls every year. Falls among the elderly are also an ominous predictor of future health decline as well, and are associated with up to 40 percent of all nursing home admissions.

While Vitamin D and calcium supplementation have previously been linked with a decrease in fractures among elderly patients, recent prospective, randomized, placebo-controlled clinical research trials have also suggested that Vitamin D supplements may act directly on muscle tissue to improve muscle strength and tone. However, because of inconsistent results among several of these prospective Vitamin D clinical trials, the true benefit of Vitamin D supplements on muscle strength, and on the risk of falls among the elderly, has been rather unclear. Now, a new meta-analysis study has exhaustively reviewed and analyzed the results of 8 different prospective, randomized, placebo-controlled Vitamin D clinical research trials that, together, included more than 2,400 research volunteers. This study has just been published in the British Medical Journal.

In this meta-analysis study, the authors identified a 19 percent decrease in the risk of falls among older patients who received high-dose (700 to 1,000 IU per day) Vitamin D supplements, when compared to research volunteers who were secretly randomized to receive lower dose (200 to 600 IU per day) Vitamin D supplements, or placebo (sugar) pills.

Interestingly, and as has also been shown in several different Vitamin D cancer prevention research studies, the amount of Vitamin D taken, and the level of Vitamin D that is present in the blood, appeared to be very important factors in reducing the risk of falls in elderly patients. Specifically, there appeared to be no significant protective effect against falls among the study volunteers who received less than 700 IU of Vitamin D per day, and in those patients who had less than 60 nanomoles per liter of active Vitamin D in their blood (elderly patients with at least 60 nanomoles per liter of the active form of Vitamin D in their blood experienced a very significant 23 percent reduction in the risk of falls!).

The findings of this meta-analysis are similar to those of other Vitamin D supplement studies that have focused on the prevention of fractures, cardiovascular disease, and cancer, in that the apparent benefit of Vitamin D in reducing the risk of these serious health complications was only observed with supplementation of Vitamin D above the typically recommended levels of 400 to 600 IU per day. In summary, the findings of this study suggest that certain levels of Vitamin D intake, as well as the level of the active form of Vitamin D in the blood, may significantly reduce the risk of falls among the elderly.

The greatest limitation of this study is that it is a meta-analysis. Meta-analysis is a retrospective research technique that is used to combine the results of multiple relatively small clinical research studies, so that a larger number of patients can be analyzed. Because individual clinical research studies rarely use identical methodologies, the most critical aspect of meta-analysis is the “equalization” of methodological differences between similar but non-identical clinical studies, so that the data produced by these different studies can be uniformly analyzed, and accurate conclusions can be drawn. Because there is some subjectivity involved in this “equalization” process, meta-analysis studies are generally not considered to provide the highest possible level of clinical research evidence, although such studies are often useful when the available clinical research data on a particular topic is scattered among multiple small prospective clinical research trials.

Before you run out to the drugstore to load up on Vitamin D supplements, let me first provide a few words of caution. First of all, high doses of Vitamin D can lead to significant toxicity and health problems. Moreover, in patients with certain chronic illnesses, Vitamin D supplementation, even at lower doses, can result in clinically significant toxicity. (These chronic illnesses include excessive parathyroid gland function, certain cancers, chronic inflammatory or infectious disorders, and some forms of kidney disease, among other less common conditions.)

Therefore, before making significant changes in your diet, to include increased Vitamin D intake, or the use of other dietary supplements, I recommend that you first discuss these proposed changes with your personal physician.

For a comprehensive update on the role of Vitamin D in cancer prevention, watch for the publication of my new book, “A Cancer Prevention Guide for the Human Race,” in early 2010.

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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

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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

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(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

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Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

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Dr. Wascher's Biography

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Links to Other Health & Wellness Sites

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http://doctorwascher.com/

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Copyright 2007 - 2009

Robert A. Wascher, MD, FACS

All rights reserved

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Dr. Wascher's Archives:

10-4-2009: Surgery, NSQIP, Complications & Death

9-27-2009 Stress, Heart Disease, Exercise & Death

9-20-2009: Vitamin D & Colorectal Cancer Survival

9-13-2009: H1N1 Swine Flu Update

9-7-2009: Green Tea, Aging & Lifespan

8-30-2009: Irritable Bowel Syndrome (IBS), Diet & Fiber

8-23-2009: Update on Prostate Cancer and Cryotherapy

8-16-2009: Exercise Improves Lymphedema Symptoms in Breast Cancer Survivors

8-9-2009: Breast Cancer Recurrence, Death & Vitamin D

8-2-2009: Honesty, Dishonesty & Brain Function

7-26-2009: Coronary Artery CT Scans & Cancer Risk

7-19-2009: Hormone Replacement Therapy (HRT) & Ovarian Cancer

7-12-2009: Breast Cancer & Metformin (Glucophage)

7-5-2009: Prostate Cancer & Green Tea

6-28-2009: Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

6-21-2009: Red Yeast Rice, Statins & Cholesterol

6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)

6-7-2009: Diet, Soy & Breast Cancer Risk

5-31-2009: Diet and Prostate Cancer Risk

5-24-2009: Diabetes, Glucose Control & Death

5-17-2009: Drug Company Marketing & Physician Prescribing Bias

5-10-2009: Hemorrhoids & Surgery

5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)

4-26-2009: Are We Really Losing the War on Cancer?

4-19-2009: Exercise in Middle Age & Risk of Death

4-12-2009: Can Chronic Stress Harm Your Heart?

4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?

3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease

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

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Dr. Wascher's Home Page

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Can Chronic Stress Harm Your Heart?

Health Report:

Can Chronic Stress Harm Your Heart?


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

By, Robert A. Wascher, MD, FACS


Updated: 04/12/2009


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.



CAN CHRONIC STRESS HARM YOUR HEART?

As we all know, we are currently living in troubling times. Anxiety and depression are widespread as recently unemployed people struggle to find jobs, while currently employed people are in constant fear of losing their jobs. Retirement portfolios have been devastated by the dual implosion of home values and the stock market, leaving many older Americans with inadequate financial reserves to meet their needs during what should have been their “golden years.” The pervasive impact of the still ongoing contraction of the global economy has rippled throughout all levels of the socioeconomic ladder, leaving the majority of our population feeling anxious and stressed, and uncertain about our futures.

Recently, I was asked by the editors of another health education website to comment on a reader’s question regarding the mechanisms whereby prolonged psychological and emotional stress are able to cause heart disease. It is well known that people who are under a great deal of stress are more prone to engage in behaviors that are associated with the development of cardiovascular disease. Poor dietary habits, avoidance of exercise, excessive alcohol intake, and smoking are all behaviors that chronically stressed people often engage in, and which have all been linked to an increased risk of heart disease. In addition to these indirect links between chronic stress and heart disease, there is also some experimental animal data suggesting that sustained elevations of the “stress hormones” cortisol, epinephrine (also known as adrenaline), and norepinephrine (noradrenaline) in the blood may directly impair heart function. However, there has been very little experimental data, to date, confirming that chronically elevated levels of “stress hormones” can directly lead to damage and dysfunction of the heart in humans.

Stress cardiomyopathy (SCM) has been described as a temporary but severe decline in heart function that is associated with periods of intense psychological, emotional, or physical stress, and occurs in patients with otherwise normal heart anatomy and function. In most cases, patients with SCM go on to recover normal heart function, although permanent damage to the heart’s muscle cells has been documented in some cases of SCM. Although the precise cause, or causes, of SCM are not well understood, previous studies of patients with severe SCM have shown elevated levels of “stress hormones” in their blood. Another potential clue regarding the pathophysiology of SCM is that patients with tumors that secrete epinephrine and norepinephrine (collectively referred to as catecholamines) can sometimes present with profound heart dysfunction as well. However, there has been no direct experimental proof, thus far, that SCM is directly caused by increased levels of catecholamine hormones in the blood. Now, a newly published clinical research study, just published in the Journal of the American College of Cardiology, provides potential evidence of such a link.

A fascinating retrospective study, performed at the Johns Hopkins University, evaluated 143 patients who were diagnosed with acute SCM between 2001 and 2008. Nine of these patients were actually documented to have acutely developed SCM following the administration of the catecholamine hormones epinephrine or dopamine. Three patients developed SCM after receiving dopamine while undergoing routine cardiac stress testing as outpatients. A fourth patient, a physician, developed SCM after intravenously injecting multiple vials of epinephrine during a suicide attempt. Four patients inadvertently received small doses of epinephrine injections directly into a vein (instead of into the tissues being operated upon) during surgical procedures, while the 9th patient inappropriately received an intravenous injection of epinephrine as treatment for a fainting spell. All of these patients developed chest pain after receiving catecholamine injections, and 6 of the 9 patients developed acute heart failure with the onset of SCM.

None of these 9 patients (average age was 44 years) had any prior clinical evidence of heart disease before receiving these catecholamine injections. In each of these 9 cases of SCM, ultrasound images of the left ventricle, the primary pumping chamber of the heart, revealed extensive abnormalities in heart muscle contraction and ventricular pumping function. EKG abnormalities suggestive of acute and moderately severe cardiac stress were also found in these 9 patients with acute catecholamine-induced SCM, while blood tests for Troponin-I, a protein that is released into the blood from damaged heart muscle cells, revealed elevated levels of this heart injury marker in all 9 patients as well. Seven of these 9 patients underwent coronary artery angiograms, and none of these 7 patients had any evidence of significant coronary artery disease by angiography. Fortunately, nearly complete recovery of left ventricular pumping function was observed in these 9 patients, on average, 7 days after the onset of SCM.

While 2 of these 9 patients clearly received an overdose of intravenous epinephrine, the remaining 7 patients received standard doses of catecholamines used for routine clinical diagnostic and therapeutic purposes. Notably, although this was a very small sample size, 7 of the 9 (78 percent) patients evaluated in this study were women. Although this intriguing study did not definitively identify a specific mechanism whereby increased blood levels of catecholamine “stress” hormones cause SCM, it does nonetheless strongly suggest that certain susceptible patients may be at increased risk of developing SCM-induced heart dysfunction due to excessive blood levels of catecholamines. In 8 of these 9 patients, acute SCM was precipitated by a single injection of either epinephrine or dopamine. Although we do not yet know why these particular patients were especially susceptible to catecholamine-induced SCM, these 9 cases raise the concern that long-term elevations of catecholamine “stress” hormones, in chronically stressed people with otherwise healthy hearts, may be capable of inducing acute or sub-acute cardiac dysfunction. Moreover, experimental animal data has shown that elevated levels of catecholamines can be directly toxic to the heart’s muscle cells and, thus, chronically elevated catecholamine levels may play a role in the eventual development of congestive heart failure in susceptible individuals. Since many of us are feeling chronically stressed-out today, and the vast majority of us will not develop SCM or congestive heart failure as a result of our high levels of stress, there are probably individual patient factors that increase the risk of stress-related cardiac dysfunction. These may include gender (7 of the 9 patients in this retrospective study were women), as well as specific, individual genetic factors. Until these potential “susceptibility factors” are better characterized, however, we are unable to determine which, if any, people might be at increased risk of stress-induced SCM, or other stress-related cardiac abnormalities, at the present time. However, this clinical study suggests that there may, indeed, be a direct potential link between high levels of stress and cardiac dysfunction.

If you feel overwhelmed by stress, anxiety or depression, please seek help through your primary physician. At the same time, although it can be very difficult during times when you already feel overwhelmed, you should abstain from heart un-healthy behaviors, and also try to work some exercise into your schedule. As I have reported upon previously in this column, multiple studies have also revealed a link between getting less than 7 hours of sleep per night with an increased mortality rate. Hopefully, these hard times will pass soon, and our collective stress levels will soon begin to fall.



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:

4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?
3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease
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

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

Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones

Health Report:


Statin Drugs & Death Rates


Physical Activity, Breast Cancer & Sex Hormones



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

By, Robert A. Wascher, MD, FACS


Last Updated: 02/15/2009

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.



STATIN DRUGS AND DEATH RATES


As I’ve mentioned in previous columns, the statin class of cholesterol-lowering drugs have revolutionized the treatment of elevated cholesterol levels, and have been shown, by multiple clinical studies, to decrease the incidence of cardiovascular events, including fatal heart attacks (myocardial infarction), in susceptible patients. While their value in reducing non-cardiovascular disease events (such as cancer, for example) continues to be debated, there is no question but that statin drugs can significantly drive down the risk of coronary artery disease in patients with elevated cholesterol levels, as well as in patients with high-normal levels of LDL (the “bad cholesterol”).


A new clinical study assessing statin drugs and death rates has just been published in the Archives of Internal Medicine. Nearly 230,000 adult patients (average age was about 58 years) enrolled in an HMO were retrospectively assessed in this huge public health study, which was performed in Israel; and all of these patients were started on statin medications between 1998 and 2006. Two general groups of patients were included in this study. The first group included patients who were prescribed statin drugs to prevent coronary artery disease, and who had no clinical evidence of coronary artery disease at the time they started receiving statins. The second group consisted of patients who were prescribed statin drugs because they already had been diagnosed with coronary artery disease. In this study, the researchers were able to determine the level of compliance of each patient with their statin medications, based upon the HMO’s pharmacy refill data.


After an average follow-up of about 5 years, the death rates among the compliant and noncompliant patients were then compared. The patients who were at least 90 percent compliant with their statin prescriptions experienced a whopping 45 percent reduction in their risk of death, from any cause, when compared to the patients who were less than 10 percent compliant with their statin medications! Furthermore, this dramatic difference in survival was observed in both the prevention group and in the coronary artery disease group.


The research data also revealed that the greatest reduction in the risk of death was observed in patients with very high baseline LDL levels, and in patients treated with more potent statin drugs. These latter two observations are especially important, because the retrospective nature of this study increases the risk that undetected biases might have influenced the researchers’ conclusions. (For example, patients who were noncompliant with their statin drugs may have also engaged in other risky health behaviors that, independent of not taking their statin drugs, might also have increased their risk of death.)


The 45 percent reduction in all-cause mortality that was associated, in this study, with a greater than 90 percent patient compliance rate with statin prescriptions is significantly greater than has been observed in most prospective randomized clinical research studies, to date. Given the retrospective nature of this study, it is not clear if the much greater mortality benefit of statin drug compliance observed in this study is entirely valid or not, but the enormous population of HMO patients included in this study, and the moderately long duration of their follow-up (albeit retrospective in nature), suggests that this study’s conclusions are probably reasonable.


If you have significant risk factors for coronary artery disease, or if you already have coronary artery disease, and your doctor has prescribed a statin drug for you, then the results of this study suggest that you can markedly reduce your risk of death by taking your medications as prescribed.



PHYSICAL ACTIVITY, BREAST CANCER & SEX HORMONES

There is considerable research evidence showing that regular exercise decreases the risk of several different types of cancer, including breast cancer. In the case of breast cancer, given that 85 to 90 percent of breast cancer cases appear to be linked in some way to exposure to estrogen and progesterone (the “female sex hormones”), most experts have assumed that increased levels of regular physical activity must somehow affect circulating sex hormone levels in the blood, but the research data in this area has been unclear. However, a new clinical research study, published in the journal Cancer Epidemiology Biomarkers & Prevention, now appears to provide evidence of a direct link between exercise and circulating sex hormone levels in the blood.

In this study, more than 800 postmenopausal women who participated in a large European public health study, the EPIC study, were evaluated. Physical activity data for these women was obtained by the use of patient questionnaires, and blood was drawn from all study participants and tested for levels of both female and male sex hormones.

The investigators soon discovered that increasing levels of physical activity resulted in decreasing levels of estrogen in the blood, as well as increased levels of a protein in the blood that binds up circulating sex hormones (sex hormone binding globulin). Furthermore, high levels of physical activity, as occurs with vigorous exercise, also increased blood levels of the male sex hormone dehydroepiandrosterone (DHEA) in these postmenopausal women.

The results of this study offer at least one potential explanation for the inverse relationship between levels of physical activity and breast cancer risk that has been identified in previous clinical studies. Irrespective of the precise mechanism(s) involved, there is ample evidence that 4 to 5 thirty-minute periods of moderate-to-vigorous exercise each week can significantly reduce a woman’s risk of developing breast cancer, and that this exercise-related risk reduction is present irrespective of whether a woman is overweight or not. Also, as we all know, exercise is good for both the heart and mind, as well!


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:

2-8-2009: 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

Home Page

Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence

Health Report:

Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding)

Obesity, Weight Loss & Urinary Incontinence
"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS


Last Updated: 02/01/2009

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.

OBESITY AND THE COMPLICATIONS OF DIVERTICULOSIS (DIVERTICULITIS & BLEEDING)

Diverticulosis is an acquired condition that results in the formation of small pouches along the wall of the colon with advancing age. Diverticulosis is known to be much more common among populations that consume western diets, which generally lack significant daily fiber intake. In less developed countries where highly processed and refined foods are not frequently consumed, and where a large percent of the diet is in the form of fresh fruits and vegetables, diverticulosis of the colon is far less common. Most patients with diverticulosis will have no symptoms of this condition. However, there are two potentially life-threatening complications that can occur when diverticulosis is present.

Diverticulosis can result in significant bleeding from the colon within a diverticulum (the small colonic pouch that causes diverticulosis). In severe cases of diverticular bleeding, blood transfusions, and even emergency surgery, may be required (in some cases, radiologists may be able to identify the site of bleeding using angiography, and may also be able to inject material into the offending artery to stop the bleeding).

A second serious complication of diverticulosis is inflammation of a diverticulum, also known as diverticulitis. Mild cases of diverticulosis frequently respond to a 10 to 14 day course of oral antibiotics, while more severe cases of diverticulitis may cause perforation of the colon and abscess formation, or even diffuse peritonitis.

As previously mentioned, a low-fiber diet is thought to be the most important mechanism underlying the formation of diverticuli in the colon (and, most commonly, in the left side of the colon). However, other risk factors may also be involved in the development of diverticulosis, as well as the complications of diverticulosis.

A new prospective clinical study, just published in the journal Gastroenterology, evaluated more than 47,000 adult male physicians between the ages of 40 and 75 years, and followed them for an average of 18 years, making this a very high-powered study. The patient volunteers in this very large prospective clinical study were closely followed through detailed health surveys that were conducted every two years. During these biennial surveys, waste circumference, hip circumference, and body weight were measured and recorded.

In this very large cohort of study volunteers, there were 801 cases of diverticulitis and 383 cases of diverticular bleeding documented during the nearly 20 year duration of this study. After evaluating the resulting clinical data, the researchers found that being obese (BMI ≥ 30 kg/meter-squared) was associated with nearly twice the risk of developing diverticulitis as was observed among men who were of normal weight (BMI ≤ 21 kg/meter-squared). Similarly, the obese men in this enormous study population experienced more than 3 times the risk of diverticular bleeding when compared to the men who were of normal weight.

When the researchers looked at waist-to-hip circumference ratio, the resulting findings were similar. Men with a high waist-to-hip ratio (or, so-called “central obesity”) were approximately twice as likely to develop diverticulitis or diverticular bleeding when compared to men with a very low waist-to-hip ratio. Even simple measurements of waist circumference revealed the same findings, as men with larger waists were found to be about twice as likely to experience diverticular bleeding and diverticulitis when compared to their counterparts with narrower waists.

As if there weren’t already enough reasons to maintain your weight within a healthy range, this huge prospective clinical study strongly suggests that obesity (as measured by BMI, weight, waist-to-hip ratio, or waist circumference) is a significant risk factor for diverticulosis and its two major complications. Although this type of study was not designed to identify the mechanism(s) whereby obesity increases the risk of diverticular complications, it is very likely that the highly-refined, high-energy diets favored by obese people plays an important role in the development of diverticulosis (and its complications) in overweight people.

So, in addition to protecting your cardiovascular system and your joints (as well as reducing your risk of cancer), maintaining a healthy weight, and eating a diet rich in fruits and vegetables and whole grains, will probably do your colon a lot of good as well!

OBESITY, WEIGHT LOSS & URINARY INCONTINENCE

Urinary incontinence is a common affliction, particularly in older women. Urinary incontinence causes varying degrees of unintended urine leakage, especially when coughing or otherwise straining. Patients with urinary incontinence often must wear special water-proof undergarments to contain leaking urine. Hysterectomy and menopause are both well-known risk factors for urinary incontinence, which explains why this condition is much more common in women than in men. Obesity has long been known to increase the risk of developing urinary incontinence as well, most likely as a result of the increased pressures that arise within the abdomen with increasing levels of obesity. However, there has been very little prospective clinical research data available to suggest that losing excess weight can, in turn, reduce the severity of urinary incontinence symptoms in women.

Now, a new study published in the current issue of the New England Journal of Medicine provides compelling evidence that weight loss in overweight and obese women can indeed significantly reduce the severity of bothersome and often embarrassing urinary incontinence symptoms.

In this prospective randomized clinical research study, 338 middle-aged overweight and obese women were randomly assigned to either an intensive 6-month weight loss program (including diet, exercise, and behavior modification) or to a structured weight loss education program. Weekly measurements of body mass index (BMI) and the number of incontinence events were then recorded for all study participants over the course of 6 months.

The women who were assigned to the intensive 6-month weight loss program lost an average of 17 pounds (or about 8 percent of their initial body weight), while the women who were randomized to the weight loss education program only lost an average of about 3 pounds (or 1.6 percent of their initial body weight). Among the women who were assigned to the intensive exercise program, there was an impressive 47 percent reduction in the number of weekly incontinence episodes! However, even the women in the diet education group, despite their rather modest weight loss, appeared to benefit, and experienced a 28 percent decrease in weekly incontinence episodes.

While the significant decline in the number of weekly incontinence episodes reported by the women randomized to diet education classes suggests that there might be a placebo effect, or other factors not directly related to weight loss, involved in the improvements observed in this study, the women who participated in the intensive exercise program, and who lost 8 percent of their initial body weight, experienced a 68 percent greater reduction in the number of incontinence episodes when compared to the “education-only” group of women.

So… keeping one’s weight in a healthy range not only reduces the risk of cardiovascular disease, arthritis, cancer, and both benign and malignant diseases of the colon, but it may also sharply reduce the distressing symptoms of urinary incontinence as well!

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 the Physician-in-Chief for Surgical Oncology at the Kaiser Permanente healthcare system in Orange County, California

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Copyright 2009

Robert A. Wascher, MD, FACS

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Dr. Wascher's Archives:

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

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