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Certain types of chemotherapy can cause heart problems, and cardiologists and oncologists need to work together to protect patients, especially those at greatest risk, say Italian researchers who reviewed available scientific literature.

Because many nations have aging populations, a growing number of people have both cancer and cardiovascular disease, the researchers said.

The review summarized the potential toxic effects of chemotherapeutic and chemopreventive drugs on the cardiovascular system. The researchers also stressed the importance of evaluating people’s cardiovascular risk before they have chemotherapy, called for new chemotherapy guidelines that include collateral effects on the cardiovascular system and recommended creation of a new interdisciplinary field of “cardio-oncology.”

Led by Adriana Albini, chief of oncology research at the Clinical and Research Institute Multimedica in Milan, the researchers said that using imaging techniques and biomarkers to identify high-risk patients would play an important role in reducing cardiovascular harm and death.

They also called for assessment of cardiotoxicity in phase 1 trials of new chemotherapy drugs that pose less heart risk.

“Today’s oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy,” the authors of the review wrote.

Heart failure occurs when a heart weakened by disease can no longer pump effectively. Before discharge heart failure patients should receive written information on:

• Eating a proper diet;
• Engaging in appropriate physical activity;
• Taking medicines correctly;
• Monitoring their weight; and
• Knowing what to do if their symptoms worsen.

However, the current fee system in the United States doesn’t encourage a focus on prevention researchers said. In their analysis, they report that doctors and hospitals are financially awarded more for treating and hospitalizing patients, not for preventing hospitalizations through such strategies as disease management.

“Physicians aren’t paid to coordinate care,” Ross said. “That physician is busy seeing patients and that’s what they’re paid to do. If we want to deliver better care, this trend is what we need to address.”

Another barrier to optimal care is a lack of communications between doctors who care for patients in the hospital and the patients’ regular physicians who help patients manage their chronic disease, Ross said. The disruption to the continuum of care can negatively affect the patient.

The average age of patients in the study was 80 years and more than half (57 percent) were women. Most patients had multiple chronic diseases: 60 percent had heart arrhythmias; 73 percent had atherosclerosis or hardening of the arteries; 49 percent had diabetes; and 29 percent had kidney failure.

“Coming back and forth into the hospital isn’t good for patients, and it isn’t good for the healthcare system,” said Ross, who plans to research the reasons heart failure patients are readmitted to the hospital. “This is a tremendous challenge.”

Findings of the study are important for patients and hospitals, Ross said.

“Patients should use this information to vet hospitals, to look at the quality of care delivered there and ask questions about the care they receive,” he said. “Hospitals should consider the rehospitalization rate a grade which, from these findings, needs improvement.”

Study highlights:
Roughly a quarter of Medicare patients hospitalized for heart failure are back in the hospital within 30 days.
The rehospitalization rate for these patients, who are over age 65, remained the same from 2004 though 2006

DALLAS, Nov. 10, 2009 – Almost a quarter of heart failure patients with Medicare are back in the hospital within a month after discharge, researchers report in Circulation: Heart Failure, a journal of the American Heart Association.

Each year, from 2004 through 2006, more than a half million Medicare recipients over age 65 went to the hospital for heart failure and were discharged alive. And each year, about 23 percent returned to the hospital within 30 days – signaling a need to improve care, researchers said. Readmission rates for all causes were almost identical all three years.

“I was hoping for improvement and was disappointed to find that was not the case,” said Joseph S. Ross, M.D., M.H.S., the study’s lead author and an assistant professor of geriatrics and palliative medicine at Mount Sinai School of Medicine in New York. “Despite the increased focus on the need to reduce readmissions, about a quarter of patients are back into the hospital within 30 days.”

Long-term use of cholesterol-lowering statins appears to reduce the incidence of gallstones and the need for surgery to prevent the excruciating pain they cause, a new study indicates.

“We’re talking about people who have been taking them for about 1½ years,” said Susan S. Jick, director of the Boston Collaborative Drug Surveillance Study at Boston University and a member of the team reporting the finding in the Nov. 11 issue of the Journal of the American Medical Association. “The protective effect seems to grow over time. The relative risk for them is about half the risk of someone who is not exposed to a statin.”

Jick, an epidemiologist, was part of an international effort in which physicians at the University of Basel in Switzerland analyzed data collected in the United Kingdom. They studied the association between the use of statins, which are prescribed to reduce the risk of cardiovascular disease, and the incidence of gallstones.

Gallstones form in the gall bladder, which contains a fluid called bile that helps digest fats. About 80 percent of the time, gallstones consist of hardened pellets of cholesterol. They can block the ducts that carry bile from the gall bladder to the small intestine, and persistent blockage is not only painful but can cause dangerous infections. In many cases, removal of the gall bladder is necessary, through a surgical procedure called a cholecystectomy.

The study compared 27,035 people who had a cholecystectomy with 106,531 who had no history of gallstones. The numbers included 11,264 people who took statins, 2,396 of them in the cholecystectomy group.

Among those diagnosed with gallstones, the researchers found a gradual reduction in the need for surgery related to how long they had taken statins. For example, 2.6 percent of the people with five to 19 statin prescriptions required surgery, compared with 2.4 percent of those not taking the medication. For those with 20 or more prescriptions, the incidence of surgery was 3.2 percent, compared with 3.7 percent for those not taking the drug.

The study indicates that all statins provide the protective effect and that the effect increases with higher doses, the report said.

But the study results do not indicate whether a statin should be prescribed solely to help prevent gallstones in someone who did not have them, said Dr. Farid Kehdy, an assistant professor of surgery at the University of Louisville.

“This would have to be studied thoroughly, prescribing a medication for something that may or may not occur,” Kehdy said.

And prescribing a statin to reduce the chance that surgery would be needed is also questionable, he said.

“You would have to take it for a year and a half to reduce the risk ratio,” Kehdy said. “Will a patient be willing to do that? It would be a daily burden if you don’t know for sure.”

Medical history indicates that such a prescription would be questionable, he said. Several decades ago, Kehdy said, physicians routinely prescribed a medication, ursodeoxycholic acid, to help dissolve gallstones, but the high cost, inconvenience and side effects of the medication led to abandonment of the practice.

So a decision to prescribe a statin should center on its known benefits in cardiovascular disease, with gallstones a side issue, he said.

“If you are on a statin, the risk of gallstones would be lessened,” Kehdy said. “If someone does not have gallstones, would you want to take a statin for the sake of preventing gallstones? That question remains to be addressed.”

Although many wedding vows include the phrase “in sickness and in health,” a stroke can put that promise to the test by causing major relationship problems for married couples, according to British researchers.

The University of Ulster study included 16 married stroke survivors (nine males, seven females), aged 33 to 78. The time since their stroke ranged from two months to four years, with an average of 18 months.

The researchers found that the stroke significantly affected sexual activity, led to blurred relationship roles, and feelings such as anger and frustration were confounded by persistent fatigue and lack of independence.

Among the findings:
All but one of the stroke survivors experienced a reduction or total loss of sexual desire. Some believed this was due to the effects of medication or fear of another stroke.
Most of the females lost interest in their appearance, regardless of age.
All the survivors said they’d changed since their stroke. Many said they experienced irritability, anger, agitation and intolerance due to their frustration at not being able to perform daily activities. In some cases, over-protective spouses increased feelings of anger and frustration.
Many survivors were reluctant to resume social activities with their spouses because of fatigue, anxiety and swallowing problems.
Fatigue was often associated with reduced independence and guilt because survivors didn’t know how they’d feel from day to day and couldn’t plan ahead.

“All the participants perceived a stroke as a life-changing event. They faced a continuous daily struggle to achieve some sense of normality and that required huge amounts of physical and mental effort,” study co-author Assumpta Ryan, of the University of Ulster’s Nursing Research Institute, said in a university news release.

While there are plenty of good reasons to avoid obesity in your teens, a new study now suggests that extra weight in adolescence may increase your risk of multiple sclerosis (MS) later.

Reporting in the Nov. 10 issue of Neurology, Harvard researchers found that being obese at age 18 more than doubles a woman’s risk of developing MS later in life compared to her slimmer peers.

“This is one more study that shows obesity leads to another unhealthy outcome, and obesity during adolescence may be critical in determining MS risk,” said study author Kassandra Munger, a research associate at the Harvard School of Public Health in Boston.

Multiple sclerosis is a chronic disorder of the central nervous system, according to the National Multiple Sclerosis Society. Although no one is certain what the exact cause of the disease is, scientists believe it’s an autoimmune disease. That means the body’s immune system mistakenly targets its own cells. In the case of MS, the immune system destroys myelin, a fatty substance that covers nerve fibers, according to the MS society.

The current study included more than 238,000 women who participated in the Nurses’ Health Study or the Nurses’ Health II study between 1976 and 2002. The women were between 25 and 55 years old at the start of the study.

Body mass index (BMI) was calculated using information given by the women about what their height and weight were when they were 18 and at the start of the study. A BMI of 18.5 to 24.9 is considered normal, according to the U.S. Centers for Disease Control and Prevention, while 25 to 29.9 is overweight and above 30 is obese.

The women were also asked to look at pictures of nine different body silhouettes that ranged in size from very thin to extremely obese, and to identify which silhouette most closely matched hers at ages 5, 10 and 20.

Women who were obese at age 18 had a 2.25 times greater risk of developing MS, according to the study. Being overweight seemed to increase the risk slightly, but not to a level that was statistically significant, Munger noted.

A large body silhouette at age 20 increased the risk of MS by 96 percent, the researchers found. A large body size at age 5 or 10 was not associated with an increased risk of MS, provided that the woman had slimmed down by age 20.

Although this study wasn’t designed to find the reason behind the increase, Munger said low vitamin D levels have been suspected of playing a role in the development of MS, and that people who are obese may have lower circulating levels of vitamin D. Another possibility, suggested Munger, is that fat tissue secretes a lot of substances that can affect the immune system.

“We’re beginning now to get clues about things that might predispose a person to MS,” said Dr. John Richert, executive vice president of research and clinical programs at the National Multiple Sclerosis Society. “Up until recently, we’ve looked at MS as a disease for which the onset can’t be controlled, and though it’s still mostly that way, maybe there are circumstances where people might be able to lower their risk a little bit. If all the incoming data [from this and other studies] is correct, not smoking and maintaining an ideal weight might lower the risk of MS.”

But, of the current study, he added, “As with so many interesting observations, this study raises a lot more questions than it answers.”

Munger noted that the study was done solely in women, so the results may not hold true for men. And, additionally, she said, the study participants were almost all white, so it’s not clear if this association would hold up for other races.

Surgery is supposed to relieve pain from injury or disease, but new research finds that between 5 percent and 10 percent of patients don’t find pain relief after an operation, and they can experience chronic pain for many months afterward.

In a new study, researchers from Germany and Denmark tried to find out what makes some people more vulnerable to post-op pain than others. They studied 463 adult men who were about to undergo surgery to repair groin hernias and followed them after their operations.

After six months, 16 percent of patients who underwent open surgery and 8 percent of patients who had laparoscopic surgery reported pain that affected their daily activities, the researchers found.

“Through our analysis, we found that persistent pain could be predicted by pain impairment of daily activities before surgery, high pain response to heat stimulation, high pain intensity reports 30 days after surgery and signs of nerve injury,” study co-author Dr. Henrik Kehlet, of Copenhagen University, said in a news release from the American Society of Anesthesiologists.

Other factors — age, anxiety, depression, other pain problems and body mass index — weren’t linked to pain after the operations, the study authors noted.

“These findings prove that persistent pain following surgery is related to both surgical and patient-specific factors, suggesting that patients with high pain response before surgery should be operated laparoscopically — a procedure that is less likely to inflict nerve damage and resulting further pain development,” Kehlet said.

Kehlet is referring to laparoscopic procedures using glue fixation of mesh. The other procedure is called open Lichetenstein mesh repair — open sutured mesh repair — and men who underwent it had a higher rate of persistent pain.

The study findings were scheduled to be presented Monday at the annual meeting of the American Society of Anesthesiologists, in New Orleans.

Nerve stem cell transplants may help slow the progression of macular degeneration, the most common cause of blindness in the developed world, U.S. researchers said on Monday.

They said putting nerve stem cells from StemCells Inc near the retinas of rats with a form of macular degeneration helped keep the disease from advancing to blindness for several months.

“These cells improve the chemical environment in the back of the eye,” said Ray Lund of the Casey Eye Institute at Oregon Health & Science University in Portland, whose findings were presented at the Society for Neuroscience meeting in Chicago.

Lund said the mechanism is not clear, but he suspects that when immature nerve cells are placed near the retina, they produce growth factors that protect the cells from damage by the disease.

“It’s basically a chemical pump that is sitting in the right place and producing the right things,” Lund said in a telephone interview.

Where normally animals with eye disease lost their vision by three months old, rats that got the transplants kept their vision for at least seven months, he said.

“There is no evidence that they (the transplanted cells) do any damage,” Lund said, adding that the animals do not develop tumors, a key worry for stem cell transplants.

The findings raise hope for use of the treatment in humans with a range of diseases in which the retina become damaged, including age-related macular degeneration or AMD, which affects nearly 30 million people worldwide, including 15 million Americans.

People with AMD lose central vision when delicate light-sensing cells of the macula, a region at the center of the retina, become damaged.

In the rats, the researchers transplanted immature nerve cells into the space near the retina. Lund said the same could be done in people with retinal disease.

Dr. Stephen Huhn, head of the Central Nervous System research program at StemCells Inc, said the cells are adult neural stem cells. He said they are multipotent, meaning they can morph into different types of nerve cells.

The company has already tested the treatment in a study of six patients with Batten’s disease, a fatal inherited disorder of the nervous system.

“Having a cell that has already entered clinical testing that has been well tolerated at very high doses in the brain gives us a lot of confidence about exploring the same type of strategy in the eye,” Huhn said.

Huhn said he thinks the cells may be especially well suited for use in the retina, brain and spinal cord, which are less likely to reject the cells than other parts of the body.

Ultimately, he said the hope is to develop a treatment for the dry form of macular degeneration, which affects around 90 percent of patients diagnosed with AMD. No treatments are available for this form of the disease.

Huhn said treating this form of the disease may prevent some people from developing wet AMD, in which tiny new blood vessels grow between the retina and the back of the eye.

This form of the disease can be treated with modern drugs like Lucentis, from Novartis and Roche’s Genentech, and Pfizer’s Macugen.

Surfing the Internet just might be a way to preserve your mental skills as you age.

Researchers found that older adults who started browsing the Web experienced improved brain function after only a few days.

“You can teach an old brain new technology tricks,” said Dr. Gary Small, a psychiatry professor at the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles, and the author of iBrain. With people who had little Internet experience, “we found that after just a week of practice, there was a much greater extent of activity particularly in the areas of the brain that make decisions, the thinking brain — which makes sense because, when you’re searching online, you’re making a lot of decisions,” he said. “It’s interactive.”

Small is co-author of the research, which was scheduled to be presented Monday in Chicago at the Society for Neuroscience annual meeting.

“This makes intuitive sense, that getting on the Internet and exploring and getting new information and learning would help,” said Paul Sanberg, director of the University of South Florida Center of Excellence for Aging and Brain Repair in Tampa. “It supports the value of exploring the Internet for the elderly.”

Most experts now advocate a “use-it-or-lose-it” approach to mental functioning.

“We found a number of years ago that people who engaged in cognitive activities had better functioning and perspective than those who did not,” said Dr. Richard Lipton, a professor of neurology and epidemiology at Albert Einstein College of Medicine in New York City and director of the Einstein Aging Study. “Our study is often referenced as the crossword-puzzle study — that doing puzzles, writing for pleasure, playing chess and engaging in a broader array of cognitive activities seem to protect against age-related decline in cognitive function and also dementia.”

The new study takes the use-it-or-lose-it concept into the 21st century.

For the research, 24 neurologically normal adults, aged 55 to 78, were asked to surf the Internet while hooked up to an MRI machine. Before the study began, half the participants had used the Internet daily, and the other half had little experience with it.

After an initial MRI scan, the participants were instructed to do Internet searches for an hour on each of seven days in the next two weeks. They then returned to the clinic for more brain scans.

“At baseline, those with prior Internet experience showed a much greater extent of brain activation,” Small said.

After at-home practice, however, those who had just been introduced to the Internet were catching up to those who were old hands, the study found.

“This is a demonstration that, over a relatively short period of time, patterns of brain activation while engaging in cognitive activities change,” Lipton said. “That is at least a first step toward gaining insight into the mechanisms that might allow cognitive engagement to influence brain function.”

But, Small said, beware how you use the Internet.

The timing and type of hormone replacement therapy women take to relieve menopausal symptoms seem to determine the degree of breast cancer risk they face, a new French study suggests.

Overall, starting estrogen-progestagen therapy soon after menopause appears to boost the risk of breast cancer, even when only used for short periods of time, according to the study, which was published in the Sept. 14 online issue of the Journal of Clinical Oncology.

Women who began the therapy in the three years after menopause and took it for two years or less had a 54 percent higher risk of breast cancer compared to those who never used the therapy, said study co-author Francoise Clavel-Chapelon, a researcher at the Institut Gustave Roussy in Villejuif, France.

However, they found an exception.

“This 54 percent increase in risk is an average, but does not seem to apply to estrogen-progesterone menopausal hormone therapy, for which no increased risk was observed when used two years or less, even close to menopause,” she said. But she noted the risk may still be present, and it was simply not found in the study due to such factors as lack of statistical power.

Many types of progestagens were taken by the women in the study; the finding that progesterone may be safer needs to be confirmed, she stressed.

The new study adds to a growing body of research that is sorting out the risks and benefits of hormone replacement therapy. Until the end of the 1990s, the therapy was viewed as largely beneficial, the authors noted. But with the release of the Women’s Health Initiative trial in 2002, research began to show the therapy boosted the risk for blood clots and breast cancer, and did not protect against heart disease, as originally believed.

Later on, some researchers hypothesized that the timing of therapy might affect patients’ heart disease risk. The French researchers decided to see if timing might affect breast cancer risk.

They turned to a large French study in which 1,726 invasive breast cancers were diagnosed among 53,310 postmenopausal women from 1992 through 2005.

They took into account hormone use, types of hormones, when the therapy was started and how long it was taken, along with comparing users and non-users.

In addition to finding a 54 percent increased risk for those who took hormone therapy for two years or less within three years of the start of menopause, they also found that short-term treatment of two years or less that was started more than three years after the beginning of menopause didn’t increase breast cancer risk. However, longer duration of use elevated risk, no matter when the therapy was begun.

The new study should serve as a warning, said Leslie Bernstein, director of the division of cancer etiology at the City of Hope National Medical Center in Duarte, Calif., who wrote an accompanying editorial.

“The missing piece is, ‘How safe is it to take right after menopause in terms of breast cancer risk?’” Bernstein said.

The French study provides some answers, but more research is needed, she said. The regimens typically taken in France are different than those taken by most U.S. women, Bernstein noted. And French women often use skin patches, not oral pills.

Any woman who is taking hormone replacement therapy should check with her doctor to see what hormone formulation is involved if she wants to more accurately assess her breast cancer risk.

While noting that the 54 percent elevated risk found by the French researchers is “worrisome,” Bernstein pointed to another study finding — that once a woman stops hormone therapy, her risk over time declines to that of the general population.

“I see this paper as a warning,” Bernstein said. “You want to take a conservative approach.”