Exercise improves quality of life for heart failure patients
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Heart failure patients who regularly exercise fare better and feel better about their lives than do similar patients who do not work out on a regular basis, say researchers at Duke University Medical Center.
The findings, reported today at the annual meeting of the American Heart Association’s Scientific Sessions 2008, go a long way toward addressing concerns about the value of exercise for the nation’s five million patients with heart failure. They also raise important policy questions for the country’s Medicare program and other insurers.
“Past studies have sent mixed signals about the merit of exercise for patients with heart failure. The HF-ACTION study (A Controlled Trial Investigating Outcomes Exercise TraiNing) shows that exercise is not only safe for patients, but also helps to improve the quality of their lives, overall,” says Kathryn Flynn, PhD, a health services researcher at Duke Clinical Research Institute (DCRI) and lead author of the study.
HF-ACTION is the largest clinical trial to date examining the value of exercise in the treatment of heart failure. Investigators enrolled 2331 patients with moderate to severe heart failure at 82 sites throughout the U.S., Canada and France from 2003 to 2008.
Researchers present new theory that may lead to effective heart failure treatments
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Do the biological underpinnings of heart failure share more in common with cancerous tumors than other cardiovascular diseases?
Research presented at American Heart Association meeting may show why heart failure treatments fail
A team of Medical University of South Carolina (MUSC) researchers and cardiologists are presenting a number of studies at the American Heart Association conference that point toward new treatments for heart failure patients.
According to the American Heart Association, more than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. It is a chronic disease that has no cure and typically worsens rapidly.
Obese kids’ artery plaque similar to middle-aged adults
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The neck arteries of obese children and teens look more like those of 45-year-olds, according to research presented at the American Heart Association’s Scientific Sessions 2008.
“There’s a saying that ‘you’re as old as your arteries,’ meaning that the state of your arteries is more important than your actual age in the evolution of heart disease and stroke,” said Geetha Raghuveer, M.D., M.P.H., associate professor of pediatrics at the University of Missouri Kansas City School of Medicine and cardiologist at Children’s Mercy Hospital. “We found that the state of the arteries in these children is more typical of a 45-year-old than of someone their own age.”
Researchers used ultrasound to measure the thickness of the inner walls of the neck (carotid) arteries that supply blood to the brain. Increasing carotid artery intima-media thickness (CIMT) indicates the fatty buildup of plaque within arteries feeding the heart muscle and the brain, which can lead to heart attack or stroke.
Staying active may lower health risks for large, retired athletes
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Study highlights:
• Retired NFL players have fewer heart disease risk factors overall, but higher cholesterol and glucose levels.
• Physical activity may have prevented the development of higher rates of diabetes or greater amounts of atherosclerosis.
• Since today’s players are 50 percent larger than 25 years ago, further study is needed on whether current players are at greater risk for cardiovascular events or death, researchers said.
NEW ORLEANS, La., Nov. 11, 2008 — The larger body size of professional football players doesn’t increase risk of cardiovascular disease or atherosclerosis after they retire, according to research presented at the American Heart Association’s Scientific Sessions 2008.
Study Sheds Light on Participants in National SEARCH for Diabetes in Youth Study
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University of South Carolina public health researchers have examined the SEARCH for Diabetes in Youth Study to characterize its participants. The findings could help other scientists understand how to recruit children and teens into future studies.
The results, published in the November issue of Contemporary Clinical Trials, found that children up to age 14 were more likely to participate in SEARCH than youths 15 - 19. White and Hispanic youths had the highest participation rates. African-American youths had the lowest participation rates.
Dr. Angela Liese, an associate professor at the university’s Arnold School of Public Health, said SEARCH participants are helping researchers understand the prevalence and incidence of diabetes in the United States and what factors lead to complications.
Exercise is safe, improves outcomes for patients with heart failure
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Working out on a stationary bicycle or walking on a treadmill just 25 to 30 minutes most days of the week is enough to modestly lower risk of hospitalization or death for patients with heart failure, say researchers from Duke Clinical Research Institute (DCRI).
The findings stem from the HF-ACTION trial (A Controlled Trial Investigating Outcomes Exercise TraiNing), the most comprehensive study to date examining the effects of exercise upon patients with heart failure. The study was reported today as a late-breaking clinical trial at the American Heart Association’s Scientific Sessions 2008 by Christopher O’Connor M.D., director of the Duke Heart Center and principal investigator of the trial, and David Whellan, M.D., of Thomas Jefferson University, co-principal investigator.
HF-ACTION enrolled 2331 patients at 82 study sites throughout the U.S., Canada and France. Patients were randomized into a group that received usual care or to a group that received usual care plus an exercise training program that began under supervision but then transitioned to home-based, self-monitored workouts.
Research Findings in Allergen Immunotherapy Unveiled
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Researchers are presenting more than 450 abstracts on investigational findings in the diagnosis and treatment of allergic diseases at the ACAAI Annual Meeting in Seattle, Nov. 6-11. Following are highlights of some key studies on allergen immunotherapy.
“Subcutaneous Immunotherapy Reduces Future Sensitization in Allergic Children under Six Years of Age.” (Abstract #18: Nov. 9 at 1:15 p.m.) – Zachary D. Jacobs, M.D., Columbia, Mo., et al – Although controversy exists over the use of allergen-specific subcutaneous immunotherapy (SCIT) among children under six, studies show it is safe and effective in this group and may prevent the development of asthma in sensitized patients. In this retrospective chart review of one Midwest allergy clinic from 1992-1997, investigators identified 59 patients on SCIT aged 18 months to 5 years for analysis. In patients receiving SCIT, sensitivities decreased 10 percent. In contrast, the control group had a highly significant increase of 62 percent in sensitivities. Authors recommend SCIT should be considered in pediatric patients with allergic rhinitis as young as 18 months to reduce future sensitizations.
“CYT003-QbG10, A Novel Allergen-independent Immunotherapy, Shown to be Safe and Efficacious in Placebo-controlled Phase II Study.” (Abstract #19: Nov. 9 at 1:30 p.m.) – Audra Blaziene, M.D., Ph.D., Vilnius, Lithuania, et al – New disease-modifying drug candidate QbG10 significantly reduces allergy symptoms in Phase II clinical trial. Current immunotherapy is based on the repeated application of allergen components, and, with up to 80 injections, it is inconvenient and may cause frequent adverse events due to allergen exposure. Here, the investigators present a completely novel allergen-independent immunotherapy that does not contain any allergen components. QbG10 consists of short stretches of synthetic DNA that are packaged into virus-like particles. In a placebo-controlled phase II study with 80 patients, six weekly injections of QbG10 have been shown to be safe, very well tolerated and efficacious in lowering allergy symptoms in daily life compared to placebo (reduction of total symptom score by -61% for QbG10 versus -32% for placebo, p=0.008). The authors conclude that this new drug candidate has potential as a convenient, well tolerated and disease-modifying therapy able to address a broad range of allergies.
Holidays Don’t Have to be Difficult for People with an Eating Disorder
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Many people equate the holidays with food – big meals equals big times. Americans, especially, attach a lot of social and personal value to what, and how, we eat, often through family rituals or attitudes. For many, family gatherings are positive events, but for the 9 million men, women or young people who have an eating disorder, the holidays, without proper planning, can feel like nightmares.
Three out of four American women have “disordered eating” behavior, and 10 percent have an eating disorder such as anorexia or bulimia nervosa or binge eating disorder, says Cynthia Bulik, Ph.D., the William and Jeanne Jordan Distinguished Professor of Eating Disorders in the UNC School of Medicine’s department of psychiatry and director of the UNC Eating Disorders Program. Her latest book, “Crave: Why you binge eat and how to stop,” is due out in early 2009.
If you have an eating disorder, plan ahead. Bulik and the UNC Eating Disorders team offer the following suggestions to navigate the food minefields of the holidays:
Protein identified that turns off HIV-fighting T cells
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In HIV-infected patients the body’s immune system is unable to fight off the virus. A new study to be published online on November 10th in the Journal of Experimental Medicine shows that T cells in HIV-infected individuals express a protein called TIM-3, which inactivates their virus killing capacity. Blocking this protein, the study suggests, might one day help patients to eliminate HIV as well as other chronic infections.
Large numbers of virus-fighting T cells can be found in the blood of most chronically infected HIV patients. However these cells eventually become exhausted and cannot function. To identify the cause of this exhaustion, a team of researchers at the University of Toronto, lead by Mario Ostrowski, compared blood from healthy individuals and HIV patients. In the patients, TIM-3 was found on a large number of HIV-specific T cells, and the number of TIM-3-positive cells increased with the severity of infection.
Under normal circumstances, exposing T cells to bits of virus causes the cells to replicate and produce virus-killing chemicals. Cells expressing TIM-3, however, were unreactive and TIM-3 was to blame; disrupting its signals restored the cells’ virus-fighting functions.
Pregnancy diabetes doubles the risk of language delay in children
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Children born to mothers with pregnancy-related diabetes run twice the risk of language development problems, according to a research team directed by Professor Ginette Dionne of Université Laval’s School of Psychology. Details of this discovery are published in the most recent issue of the scientific journal Pediatrics.
Researchers compared the vocabulary and grammar skills of 221 children whose mothers were diagnosed with gestational diabetes to those of 2,612 children from a control group. These tests were conducted at different intervals between ages 18 months and 7 years.
Results showed that children born to mothers with gestational diabetes achieve poorer scores on tests of spoken vocabulary and grammar than children of healthy mothers. The differences between the two groups are probably due to the effects of gestational diabetes on the brain development of babies. The study shows that these effects persist even after the children start school.
How women can improve their quality of life after breast cancer treatment
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Women need to be well-informed about options for minimising harm from breast cancer treatment / Acting early could avoid long-term problems like lymphedema
Cologne, Germany: 6 November 2008. Opting for less damaging treatments, staying active and learning about the warning signs of lymphedema: that’s how women with breast cancer can avoid developing chronic lymphedema, according to the German Institute for Quality and Efficiency in Health Care (IQWiG). Women can learn more about how to protect themselves from this common and distressing adverse effect of treatment as well as handle the condition at the Institute’s website, http://www.informedhealthonline.org.
Protecting women’s lymph systems
Breast cancer treatment is becoming more effective, with a survival rate of more than 80% for this disease in Germany.
Efficacy, Dosage Concerns Unresolved on Sublingual Immunotherapy
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Although sublingual immunotherapy (SLIT) is used in Europe and other countries, experts at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Seattle say questions remain unanswered regarding its effectiveness, appropriate use, dosage, and safety of administration.
“Sublingual immunotherapy has gained wide acceptance in the treatment of allergic disease throughout Europe and South America, but the research studies in the United States have yet to show results that will convince the FDA to approve a product,” said Ira Finegold, M.D., clinical professor of medicine at Columbia University and chairman of the R.A. Cook Institute of Allergy, St. Luke’s-Roosevelt Hospital, New York.
“The main advantage of SLIT over traditional immunotherapy is patient convenience, since it is not an injection but oral drops or tablets that can be administered at home, and it appears to be safer than conventional immunotherapy,” he said.
Clinical Guideline on Prevention of Cardiovascular Disease and Diabetes in Patients at Highest Risk
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Clinical Guideline on Prevention of Cardiovascular Disease and Diabetes in Patients at Highest Risk Released
The Endocrine Society has released a new clinical practice guideline for the primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk. The guideline appears in the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
There is growing evidence that many patients who develop cardiovascular disease or diabetes have a pre-existing metabolic risk. This risk includes conditions such as enlarged waist circumference, hypertension, and elevated plasma glucose levels. The presence of three of more such conditions should alert a clinician to a patient at metabolic risk, said Dr. James Rosenzweig, director of diabetes services in the Section of Endocrinology, Diabetes and Nutrition at Boston Medical Center, and chair of the task force that developed this guideline.
“The dramatic increase in the incidence of patients at risk for cardiovascular disease and diabetes throughout the developed and developing world requires physicians and other care providers to be aware of the risk factors for these conditions and identify patients at risk in order to initiate treatment,” said Dr. Rosenzweig. “This guideline was developed for just this purpose.”
Review examines breast cancer prevention strategies in the United States
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A new review outlines potential pharmaceutical, dietary, surgical, and other approaches to reducing the risk of breast cancer among women in the United States, and examines the evidence for specific recommendations.
The review says risk reduction strategies for women at average risk of breast cancer should focus primarily on lifestyle factors. Among the recommendations: aside from following general dietary recommendations for healthy eating, there is no clear evidence that specific dietary components can effectively reduce breast cancer risk; while all women should be advised to moderate alcohol use, women at increased risk of breast cancer should moderate alcohol intake or even avoid alcohol; women should maintain a healthy body weight, since gaining over 20 pounds during adulthood has been reported to result in an increased risk of breast cancer.
The authors say use of pharmacotherapy to reduce the risk should be individualized to each patient after a thorough discussion of risks and benefits as part of a shared decision-making process.
Experts Available to Comment on New Study about Risk of Sudden Cardiac Death
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A new study in the November 5th 2008 issue of JAMA finds that during the first month after a heart attack, patients may have an increased risk for sudden cardiac death.
“The study justifies why we are so aggressive in treating patients during and after myocardial infarction,” says Howard S Weintraub, MD, FACC, clinical director of Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center. “If you survive the first thirty days, your risk is lowered over the next months to years.”
According to Dr. Weintraub, patients at risk for sudden cardiac death during the first month are those with recurrent chest pain (similar to the symptoms they had with their heart attack) and heart failure. “Identification of people at risk is very important,” says Dr. Weintraub. “Patients should be very vigilant reporting symptoms of shortness of breath, especially when lying down, ankle swelling, recurrent symptoms of chest pain, symptoms similar to initial heart attack experience, or problems during exertion or at rest.” They should also understand that using the medications that were prescribed on discharge may be influential in preventing recurrent ischemia and the risk of sudden cardiac death.
