WASHINGTON (Reuters) - Statin drugs may help prevent the brain damage that leads to Alzheimer's disease, U.S. researchers reported on Monday.
Their study, published in the journal Neurology, bolsters a growing body of research that suggests the popular cholesterol-lowering drugs may reduce the risk of Alzheimer's.
Most studies have simply compared people who take statin drugs to those who do not, and track the rate of Alzheimer's.
"But our study is the first to compare the brains of people who had received statins with those who had not," said Dr. Gail Ge Li of the University of Washington School of Medicine in Seattle, who worked on the study.
Li and colleagues examined the brains of 110 people aged 65 to 79 who had donated their brains for research after they died as part of a study when they were still living.
The researchers looked at the brains for evidence of the plaques and tangles that characterize Alzheimer's, an incurable and progressive brain disease that is the leading cause of dementia.
They found significantly fewer tangles in the brains of people who had taken statins than in those who had not.
"These results are exciting, novel, and have important implications for prevention strategies," said Dr. Eric Larson, who helped direct the study.
"But they need to be confirmed, because (ours) is not a randomized controlled trial."
Such a trial would be difficult to conduct. It would require randomly assigning people to either take statins or not, watching to see who developed Alzheimer's, and looking at their brains after they died.
Statin drugs lower cholesterol and may also reduce inflammation in the body. The causes of Alzheimer's are not fully understood, but they are closely linked with cholesterol and also inflammation.
"Statins are probably more likely to help prevent the disease in certain kinds of people than others," Li said.
"Someday we may be able to know more precisely which individuals will benefit from which types of statins for preventing the changes of Alzheimer's disease," Larson added in a statement.
Statins -- which include Pfizer Inc's $10 billion-a-year Lipitor, Bristol-Myers Squibb Co's Pravachol and Merck and Co Inc's Zocor -- are the world's best-selling drugs, taken by millions to reduce the risk of heart attack.
Monday, August 27, 2007
Wednesday, August 22, 2007
Behind Atherosclerosis
Diesel: The Engine Behind Atherosclerosis?
The combination of cholesterol and particles from diesel exhaust can harden arteries and lead to heart attacks and strokes, according to a new study. The two factors together appear to be much more harmful than the effects of soot containing diesel particles or cholesterol alone, the researchers found.
The relation between diesel fumes--which contain particles less than 2.5 micrometers in diameter--and cardiovascular disease is still unclear. Epidemiological evidence has shown a link, but researchers are unsure about the mechanism. Studies have suggested, however, that like the "bad" form of cholesterol known as low density lipoprotein (LDL), diesel particles cause the release into blood vessels of free radicals, a type of oxygen molecule that is damaging to human tissue.
In the new study, immunologist Andre Nel of the University of California, Los Angeles, and his colleagues exposed samples of human vascular tissue to soot, LDL cholesterol, or both at the same time. The researchers found that the combination was especially adept at setting off genes known to cause inflammation of the blood vessels and at promoting artery hardening, or atherosclerosis.
To test whether the same was true in live animals, researchers took mice genetically engineered to have high cholesterol levels and placed them in one of three environments. The first group was exposed to filtered air for 2 months, the second to the finest particles in diesel fumes, and the third group to both fine and intermediate-sized particles. Examination of the animals' lungs showed that the two diesel groups had the same amount of damage as did the human tissue samples and similar gene activation patterns. The mice exposed to only the finest particles had the most severe damage. The study is published in the 25 July issue of Genome Biology.
"This the first study to go so far into the biology behind the effect air pollutants have on the cardiovascular system," says Stanton Glantz, a toxicologist at the University of California, San Francisco. "Most people figured there was something going on, but this gives us substantial evidence."
In future studies, Nel says he hopes to discover whether antioxidants--compounds that are found in some fruits and vegetables and that can prevent harm from free radicals--can prevent damage from diesel fumes. His team also plans on identifying genes that make people more susceptible to the effects of air pollutants, so that high-risk people may be identified with a DNA test.
So be aware of pollution.
and be healthy..
mitul patel
The combination of cholesterol and particles from diesel exhaust can harden arteries and lead to heart attacks and strokes, according to a new study. The two factors together appear to be much more harmful than the effects of soot containing diesel particles or cholesterol alone, the researchers found.
The relation between diesel fumes--which contain particles less than 2.5 micrometers in diameter--and cardiovascular disease is still unclear. Epidemiological evidence has shown a link, but researchers are unsure about the mechanism. Studies have suggested, however, that like the "bad" form of cholesterol known as low density lipoprotein (LDL), diesel particles cause the release into blood vessels of free radicals, a type of oxygen molecule that is damaging to human tissue.
In the new study, immunologist Andre Nel of the University of California, Los Angeles, and his colleagues exposed samples of human vascular tissue to soot, LDL cholesterol, or both at the same time. The researchers found that the combination was especially adept at setting off genes known to cause inflammation of the blood vessels and at promoting artery hardening, or atherosclerosis.
To test whether the same was true in live animals, researchers took mice genetically engineered to have high cholesterol levels and placed them in one of three environments. The first group was exposed to filtered air for 2 months, the second to the finest particles in diesel fumes, and the third group to both fine and intermediate-sized particles. Examination of the animals' lungs showed that the two diesel groups had the same amount of damage as did the human tissue samples and similar gene activation patterns. The mice exposed to only the finest particles had the most severe damage. The study is published in the 25 July issue of Genome Biology.
"This the first study to go so far into the biology behind the effect air pollutants have on the cardiovascular system," says Stanton Glantz, a toxicologist at the University of California, San Francisco. "Most people figured there was something going on, but this gives us substantial evidence."
In future studies, Nel says he hopes to discover whether antioxidants--compounds that are found in some fruits and vegetables and that can prevent harm from free radicals--can prevent damage from diesel fumes. His team also plans on identifying genes that make people more susceptible to the effects of air pollutants, so that high-risk people may be identified with a DNA test.
So be aware of pollution.
and be healthy..
mitul patel
Friday, August 17, 2007
Whole grains may lower odds of high blood pressure
NEW YORK (Reuters Health) - Women who get plenty of whole grains in their diet may lower their risk of developing high blood pressure, a large study suggests.
Researchers found that middle-aged and older women who ate the most whole grains were less likely than those with the lowest intakes to develop high blood pressure over the next 10 years.
The benefit was modest. Women who consumed the most whole grains had an 11-percent lower risk of high blood pressure than those with the lowest intakes.
But the findings add to evidence of the cardiovascular benefits of whole grains such as oatmeal, bran and brown rice. Past studies have tied diets rich in these foods to lower risks of heart disease and stroke.
The fiber and other nutrients in whole grains may help lower cholesterol, blood sugar and insulin levels, as well as improve blood vessel functioning and reduce inflammation in the circulatory system. Whether whole grains benefit blood pressure has been unclear, however.
For the current study, researchers at Harvard University in Boston used data from the Women's Health Study, which has followed nearly 40,000 U.S. female health professionals since 1992. Upon entering the study, the women completed detailed questionnaires on their diet habits, including their usual intake of whole-grain foods like dark bread, popcorn, oatmeal and whole-grain breakfast cereals.
Of the nearly 30,000 women who were free of high blood pressure at the outset, those who ate the most whole grains had a lower risk of developing the condition. The apparent protective effect held when the researchers considered other factors, like weight, smoking and exercise habits.
In contrast, refined grains -- like pasta, white bread and other foods made from white flour -- were unrelated to high blood pressure risk, according to the researchers, led by Dr. Lu Wang.
Unlike whole grains, refined grains are largely stripped of the fiber- and nutrient-rich bran and germ components of the plant. This difference may explain why only whole grains were related to lower blood pressure, according to Wang's team.
The findings, the researchers conclude, suggest that people may do their blood pressure and heart health some good by replacing refined-grain foods with whole grains.
SOURCE: American Journal of Clinical Nutrition, August 2007.
Researchers found that middle-aged and older women who ate the most whole grains were less likely than those with the lowest intakes to develop high blood pressure over the next 10 years.
The benefit was modest. Women who consumed the most whole grains had an 11-percent lower risk of high blood pressure than those with the lowest intakes.
But the findings add to evidence of the cardiovascular benefits of whole grains such as oatmeal, bran and brown rice. Past studies have tied diets rich in these foods to lower risks of heart disease and stroke.
The fiber and other nutrients in whole grains may help lower cholesterol, blood sugar and insulin levels, as well as improve blood vessel functioning and reduce inflammation in the circulatory system. Whether whole grains benefit blood pressure has been unclear, however.
For the current study, researchers at Harvard University in Boston used data from the Women's Health Study, which has followed nearly 40,000 U.S. female health professionals since 1992. Upon entering the study, the women completed detailed questionnaires on their diet habits, including their usual intake of whole-grain foods like dark bread, popcorn, oatmeal and whole-grain breakfast cereals.
Of the nearly 30,000 women who were free of high blood pressure at the outset, those who ate the most whole grains had a lower risk of developing the condition. The apparent protective effect held when the researchers considered other factors, like weight, smoking and exercise habits.
In contrast, refined grains -- like pasta, white bread and other foods made from white flour -- were unrelated to high blood pressure risk, according to the researchers, led by Dr. Lu Wang.
Unlike whole grains, refined grains are largely stripped of the fiber- and nutrient-rich bran and germ components of the plant. This difference may explain why only whole grains were related to lower blood pressure, according to Wang's team.
The findings, the researchers conclude, suggest that people may do their blood pressure and heart health some good by replacing refined-grain foods with whole grains.
SOURCE: American Journal of Clinical Nutrition, August 2007.
Wednesday, August 15, 2007
Decline in U.S. Breast Cancers Tied to Drop in Hormone Use
TUESDAY, Aug. 14 (HealthDay News) -- A decline in women's use of hormone therapy, not any drop in mammography-linked detection, is likely responsible for the recent U.S. drop in breast cancers, says new research.
"Ours is the only study that has looked at a purely screened population. I think our study definitely says that that it's not because of screening," said lead researcher Dr. Karla Kerlikowske, professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco, and director of the Women Veterans Comprehensive Health Center, part of the VA San Francisco.
"With the data that we have, hormones are the most logical explanation," said Kerlikowske, whose team published its findings online Aug. 14 in the Journal of the National Cancer Institute.
"This is pretty profound," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "Women have to make decisions in their lives, and the drugs [hormones] have not been taken off market. Women have to understand there is an associated risk of developing breast cancer when taking combined estrogen and progestin," he said.
The UCSF study follows closely on the heels of several others that have tried to explain a sharp decline in breast cancer incidence in 2003 to 2004.
The drop coincided with a rapid decline in postmenopausal hormone therapy starting in 2002, when the results of the Women's Health Initiative (WHI) were released. The WHI was halted early after researchers found elevated health risks, including breast cancer, among women taking the combined formulation of estrogen plus progestin.
Some have suggested that a decline in screening mammography was responsible, but other studies, including one published in July in JNCI, also found hormone therapy to be the likely culprit.
Kerlikowske and her colleagues looked at data on more than 600,000 mammograms performed between 1997 and 2003 on women aged 50 to 69.
In this group of women, use of hormone therapy declined by 7 percent a year between 2000 and 2002, then by 34 percent annually between 2002 and 2003.
Over the same period of time, breast cancer rates declined annually by 5 percent and estrogen-receptor-positive breast cancer rates fell by 13 percent annually from 2001 to 2003, a significant association.
The message for women?
"Women should hopefully take hormone therapy for as short a time as possible for [menopausal] symptoms," Kerlikowske said.
There is also some reassurance in the fact that breast cancer risk goes down when hormone therapy is discontinued, she added, although more data on this phenomenon is needed.
Convincing some women to curtail the use of HRT might be difficult, however.
"The problem is, we've grown so used in the last 40 or 50 years to having women take hormones that it's hard to break that paradigm shift," Brooks said. "A lot of women and a lot of doctors think that if I take hormones, I'm going to stay youthful, and that's a hard thing to break. But the data is the data."
More information
There's more on the Women's Health Initiative at the U.S. National Institutes of Health.
"Ours is the only study that has looked at a purely screened population. I think our study definitely says that that it's not because of screening," said lead researcher Dr. Karla Kerlikowske, professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco, and director of the Women Veterans Comprehensive Health Center, part of the VA San Francisco.
"With the data that we have, hormones are the most logical explanation," said Kerlikowske, whose team published its findings online Aug. 14 in the Journal of the National Cancer Institute.
"This is pretty profound," added Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "Women have to make decisions in their lives, and the drugs [hormones] have not been taken off market. Women have to understand there is an associated risk of developing breast cancer when taking combined estrogen and progestin," he said.
The UCSF study follows closely on the heels of several others that have tried to explain a sharp decline in breast cancer incidence in 2003 to 2004.
The drop coincided with a rapid decline in postmenopausal hormone therapy starting in 2002, when the results of the Women's Health Initiative (WHI) were released. The WHI was halted early after researchers found elevated health risks, including breast cancer, among women taking the combined formulation of estrogen plus progestin.
Some have suggested that a decline in screening mammography was responsible, but other studies, including one published in July in JNCI, also found hormone therapy to be the likely culprit.
Kerlikowske and her colleagues looked at data on more than 600,000 mammograms performed between 1997 and 2003 on women aged 50 to 69.
In this group of women, use of hormone therapy declined by 7 percent a year between 2000 and 2002, then by 34 percent annually between 2002 and 2003.
Over the same period of time, breast cancer rates declined annually by 5 percent and estrogen-receptor-positive breast cancer rates fell by 13 percent annually from 2001 to 2003, a significant association.
The message for women?
"Women should hopefully take hormone therapy for as short a time as possible for [menopausal] symptoms," Kerlikowske said.
There is also some reassurance in the fact that breast cancer risk goes down when hormone therapy is discontinued, she added, although more data on this phenomenon is needed.
Convincing some women to curtail the use of HRT might be difficult, however.
"The problem is, we've grown so used in the last 40 or 50 years to having women take hormones that it's hard to break that paradigm shift," Brooks said. "A lot of women and a lot of doctors think that if I take hormones, I'm going to stay youthful, and that's a hard thing to break. But the data is the data."
More information
There's more on the Women's Health Initiative at the U.S. National Institutes of Health.
Tuesday, August 14, 2007
Diabetes drugs to include new warnings
WASHINGTON - The diabetes drugs Avandia and Actos will be labeled with severe warnings about a risk of heart failure to some patients, health officials said Tuesday.
The makers of the drugs, GlaxoSmithKline Plc and Takeda Pharmaceutical Company Ltd., have agreed to add the "black-box" warnings, the Food and Drug Administration said. The warnings, the most severe that prescription drugs can bear, stress the medicines may cause or worsen heart failure and that patients should be closely monitored.
The warnings also apply to combination drugs that include the active ingredients in Avandia, made by Glaxo, or Takeda's Actos. The drugs help patients with Type 2 diabetes control their blood sugar levels.
The warnings, which the FDA said in June it would seek, are separate from concerns that Avandia also raises the risk of heart attack. FDA advisers said last month the risk appeared real but that the evidence wasn't conclusive enough to merit pulling Avandia from the market. They did recommend Avandia's label be updated to include information on that risk. The FDA said it was continuing its review of the issue.
Separately, an FDA review of reports of side effects in patients taking either Avandia or Actos found cases of significant weight gain and build up of fluids, both of which are warning signs of heart failure, the agency said.
___
On the Net:
FDA Avandia information: http://www.fda.gov/cder/drug/infopage/rosiglitazone/default.htm
FDA Actos information: http://www.fda.gov/cder/drug/infopage/pioglitazone/default.htm
The makers of the drugs, GlaxoSmithKline Plc and Takeda Pharmaceutical Company Ltd., have agreed to add the "black-box" warnings, the Food and Drug Administration said. The warnings, the most severe that prescription drugs can bear, stress the medicines may cause or worsen heart failure and that patients should be closely monitored.
The warnings also apply to combination drugs that include the active ingredients in Avandia, made by Glaxo, or Takeda's Actos. The drugs help patients with Type 2 diabetes control their blood sugar levels.
The warnings, which the FDA said in June it would seek, are separate from concerns that Avandia also raises the risk of heart attack. FDA advisers said last month the risk appeared real but that the evidence wasn't conclusive enough to merit pulling Avandia from the market. They did recommend Avandia's label be updated to include information on that risk. The FDA said it was continuing its review of the issue.
Separately, an FDA review of reports of side effects in patients taking either Avandia or Actos found cases of significant weight gain and build up of fluids, both of which are warning signs of heart failure, the agency said.
___
On the Net:
FDA Avandia information: http://www.fda.gov/cder/drug/infopage/rosiglitazone/default.htm
FDA Actos information: http://www.fda.gov/cder/drug/infopage/pioglitazone/default.htm
Thursday, August 9, 2007
MRI scans might prevent breast cancer, study shows
WASHINGTON (Reuters) - MRI scans may offer a new way to detect breast cancer at its earliest stages and perhaps even prevent cancer among high-risk women, European researchers said on Thursday.
Details of a German study show that magnetic resonance imaging was better than standard mammograms, a type of X-ray, at detecting a nonmalignant tumor called ductal carcinoma in-situ, or DCIS.
This could give surgeons time to remove the lesion before it can turn cancerous.
The findings, published in the Lancet medical journal, suggest that MRI should be tested in more women to see if it should become a standard screening tool, said Dr. Carla Boetes and Dr. Ritse Mann of the Radboud University Nijmegen Medical Centre in the Netherlands.
"Although these results were unexpected, the pathophysiology of breast cancer provides ample justification for the findings," they wrote in a commentary in Lancet.
Boetes and Mann noted that autopsy results show that about 9 percent of women have undetected DCIS, and that almost all malignant breast cancer is believed to start out as DCIS.
"MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer at its earliest stage," they wrote.
Dr. Christiane Kuhl, a radiologist at the University of Bonn and colleagues studied 7,319 women over five years for their study, which was also presented in June to a meeting of the American Society of Clinical Oncology.
MRI found DCIS in more than 90 percent of the 167 women with the condition, while mammograms only found 56 percent of DCIS cases.
"MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade," Kuhl's team wrote.
TOO SOON TO RECOMMEND
But Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, said it is far too soon to use MRI routinely for breast cancer screening.
"The American Cancer Society recommends that MRI screening be done annually in addition to mammography starting at age 30 for women at high risk," Saslow said in a telephone interview.
"For the most part, these are women who have had either a genetic test or found a mutation (that puts them at high risk of developing breast cancer), there is a mutation in the family, or there is a strong enough family history that would lead you to think that the risk of having a mutation is pretty high," she added.
Women who already have had breast cancer have only a moderate risk of a recurrence and are not necessarily candidates for MRI, Saslow said. The reason is that MRI is expensive -- $1,000 to $1,500 per scan -- and has a high rate of false positives, meaning it detects lesions that are harmless.
"Sometimes doctors will think they see something. With MRI it is not clear-cut," Saslow said. "Some of those women are choosing to have mastectectomies."
And having an MRI does not save women from undergoing the uncomfortable mammogram process, as MRIs are always done alongside mammograms, Saslow noted. "Mammography still finds things that an MRI doesn't," she said.
Breast cancer is diagnosed in 1.2 million men and women globally every year and kills 500,000.
Details of a German study show that magnetic resonance imaging was better than standard mammograms, a type of X-ray, at detecting a nonmalignant tumor called ductal carcinoma in-situ, or DCIS.
This could give surgeons time to remove the lesion before it can turn cancerous.
The findings, published in the Lancet medical journal, suggest that MRI should be tested in more women to see if it should become a standard screening tool, said Dr. Carla Boetes and Dr. Ritse Mann of the Radboud University Nijmegen Medical Centre in the Netherlands.
"Although these results were unexpected, the pathophysiology of breast cancer provides ample justification for the findings," they wrote in a commentary in Lancet.
Boetes and Mann noted that autopsy results show that about 9 percent of women have undetected DCIS, and that almost all malignant breast cancer is believed to start out as DCIS.
"MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer at its earliest stage," they wrote.
Dr. Christiane Kuhl, a radiologist at the University of Bonn and colleagues studied 7,319 women over five years for their study, which was also presented in June to a meeting of the American Society of Clinical Oncology.
MRI found DCIS in more than 90 percent of the 167 women with the condition, while mammograms only found 56 percent of DCIS cases.
"MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade," Kuhl's team wrote.
TOO SOON TO RECOMMEND
But Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, said it is far too soon to use MRI routinely for breast cancer screening.
"The American Cancer Society recommends that MRI screening be done annually in addition to mammography starting at age 30 for women at high risk," Saslow said in a telephone interview.
"For the most part, these are women who have had either a genetic test or found a mutation (that puts them at high risk of developing breast cancer), there is a mutation in the family, or there is a strong enough family history that would lead you to think that the risk of having a mutation is pretty high," she added.
Women who already have had breast cancer have only a moderate risk of a recurrence and are not necessarily candidates for MRI, Saslow said. The reason is that MRI is expensive -- $1,000 to $1,500 per scan -- and has a high rate of false positives, meaning it detects lesions that are harmless.
"Sometimes doctors will think they see something. With MRI it is not clear-cut," Saslow said. "Some of those women are choosing to have mastectectomies."
And having an MRI does not save women from undergoing the uncomfortable mammogram process, as MRIs are always done alongside mammograms, Saslow noted. "Mammography still finds things that an MRI doesn't," she said.
Breast cancer is diagnosed in 1.2 million men and women globally every year and kills 500,000.
Monday, August 6, 2007
Doctors refine heart attack guidelines
CHICAGO (Reuters) - U.S. heart experts are calling for a two-pronged approach for treating patients with chest pain or heart attacks caused by partially blocked arteries, physicians groups said on Monday.
The new guidelines, issued jointly by the American Heart Association and the American College of Cardiology, refine 2002 recommendations and suggest steps for treating patients based on better information about who might better benefit from medical versus invasive therapy.
"The guidelines are emphasizing the importance of determining risk early on in these patients and choosing the right therapy," said Dr. Sidney Smith, a cardiologist at the University of North Carolina and a past president of the American Heart Association.
They differentiate between high-risk and low-risk patients with unstable chest pain or non-ST elevation myocardial infarction, a type of mild heart attack that does not cause changes on an electro-cardiogram.
"Medical therapy should be used in many patients with low-risk who previously might have been sent out without important attention to these therapies," Smith said in a telephone interview.
The new guidelines suggest that stabilized and lower-risk patients get a stress test, an echo-cardiogram and other tests of heart function.
These patients also should receive a number of therapies to prevent a second heart attack, including the use of ACE inhibitors -- drugs that protect the heart muscle -- and other drugs. And they place greater emphasis on smoking cessation and better control of cholesterol and blood pressure.
High-risk patients will still be recommended for early intervention, such as the opening the blockages with a balloon-tipped catheter and inserting a device called a stent to keep the artery open.
Patients who receive a drug-eluting stent -- which releases a drug to keep the artery open -- should also receive 12 months of treatment with the anti-platelet drug clopidogrel, sold by Bristol-Myers Squibb Co. as Plavix.
The guidelines emphasize use of Plavix even among those who do not receive a stent, Smith said.
Coronary artery disease is the leading cause of death in the United States and unstable angina and non-ST elevation myocardial infarction are acute forms of this disease.
The new guidelines, issued jointly by the American Heart Association and the American College of Cardiology, refine 2002 recommendations and suggest steps for treating patients based on better information about who might better benefit from medical versus invasive therapy.
"The guidelines are emphasizing the importance of determining risk early on in these patients and choosing the right therapy," said Dr. Sidney Smith, a cardiologist at the University of North Carolina and a past president of the American Heart Association.
They differentiate between high-risk and low-risk patients with unstable chest pain or non-ST elevation myocardial infarction, a type of mild heart attack that does not cause changes on an electro-cardiogram.
"Medical therapy should be used in many patients with low-risk who previously might have been sent out without important attention to these therapies," Smith said in a telephone interview.
The new guidelines suggest that stabilized and lower-risk patients get a stress test, an echo-cardiogram and other tests of heart function.
These patients also should receive a number of therapies to prevent a second heart attack, including the use of ACE inhibitors -- drugs that protect the heart muscle -- and other drugs. And they place greater emphasis on smoking cessation and better control of cholesterol and blood pressure.
High-risk patients will still be recommended for early intervention, such as the opening the blockages with a balloon-tipped catheter and inserting a device called a stent to keep the artery open.
Patients who receive a drug-eluting stent -- which releases a drug to keep the artery open -- should also receive 12 months of treatment with the anti-platelet drug clopidogrel, sold by Bristol-Myers Squibb Co. as Plavix.
The guidelines emphasize use of Plavix even among those who do not receive a stent, Smith said.
Coronary artery disease is the leading cause of death in the United States and unstable angina and non-ST elevation myocardial infarction are acute forms of this disease.
Wednesday, August 1, 2007
New TB vaccine shows promise in animal studies
WASHINGTON (Reuters) - A new tuberculosis vaccine has shown promise in animal studies, researchers said on Wednesday, raising hope it might replace the current vaccine that has failed to stop one of the world's top killers.
If all goes well, human trials of the new vaccine with some modifications to make it safer could start in two to three years, said one of the researchers, immunologist Dr. Steven Porcelli of Albert Einstein College of Medicine in New York.
TB, a bacterial infection that usually attacks the lungs, kills about 1.6 million people a year globally. The increasing resistance of the TB organism to drug treatments makes creation of a truly effective vaccine even more crucial, experts say.
The existing BCG vaccine, in use for almost a century despite its limited effectiveness, is based on a live, weakened strain of the bacterium that causes TB in cattle.
Rather than trying to make changes in the BCG vaccine, the researchers decided to take a different path, using a weakened version of the bacterium that causes TB in people.
The idea behind this and other vaccines is to make the body's immune system -- its natural defenses -- better able to fight off invaders like disease-causing bacteria or viruses.
The researchers found a gene in the organism that helps it elude immune system detection, and removed it from the bacterium. That helps the vaccine, using this live, weakened version of the organism, induce a strong immune response.
They tested the new vaccine head-to-head against the existing one. They found that the new one extended the lives of mice and guinea pigs and stimulated stronger immune responses in those animals compared to the existing BCG vaccine.
"It seems to be translating directly into something that might be of great benefit to humanity. So I feel extremely energized and quite optimistic about where this project is leading," Porcelli said in a telephone interview.
"SOME LIMITATIONS"
"It has some limitations. A major one at this point is that it's still probably too infectious to give to humans. It's only partially attenuated, or weakened, for virulence," he added.
The work appears in the Journal of Clinical Investigation.
Porcelli said the researchers are working to make the vaccine safer by removing additional genes. He said they plan to test it in monkeys. He said if the results continue to be positive, human studies may be possible in two to three years.
"We're very excited because this is the first vaccine strain we've ever seen that is significantly better than BCG," said another researcher, William Jacobs of Albert Einstein College of Medicine and the Howard Hughes Medical Institute.
The TB organism infects roughly a third of the world's population. Most infections remain latent but can become active when the immune system is weakened, for example in people also infected by the virus that causes AIDS. About 10 million people worldwide have active cases of TB.
The existing BCG vaccine protects young children from tuberculosis, but does not do well at preventing the type of TB most adolescents and adults develop.
TB can be treated effectively with drugs in many cases, but the drugs have to be given daily for upward of six months, making treatment complicated and expensive. Many poorer parts of the world lack the medical infrastructure to deliver that kind of treatment, so many experts believe an effective vaccine could be a highly valuable tool in combating the disease.
If all goes well, human trials of the new vaccine with some modifications to make it safer could start in two to three years, said one of the researchers, immunologist Dr. Steven Porcelli of Albert Einstein College of Medicine in New York.
TB, a bacterial infection that usually attacks the lungs, kills about 1.6 million people a year globally. The increasing resistance of the TB organism to drug treatments makes creation of a truly effective vaccine even more crucial, experts say.
The existing BCG vaccine, in use for almost a century despite its limited effectiveness, is based on a live, weakened strain of the bacterium that causes TB in cattle.
Rather than trying to make changes in the BCG vaccine, the researchers decided to take a different path, using a weakened version of the bacterium that causes TB in people.
The idea behind this and other vaccines is to make the body's immune system -- its natural defenses -- better able to fight off invaders like disease-causing bacteria or viruses.
The researchers found a gene in the organism that helps it elude immune system detection, and removed it from the bacterium. That helps the vaccine, using this live, weakened version of the organism, induce a strong immune response.
They tested the new vaccine head-to-head against the existing one. They found that the new one extended the lives of mice and guinea pigs and stimulated stronger immune responses in those animals compared to the existing BCG vaccine.
"It seems to be translating directly into something that might be of great benefit to humanity. So I feel extremely energized and quite optimistic about where this project is leading," Porcelli said in a telephone interview.
"SOME LIMITATIONS"
"It has some limitations. A major one at this point is that it's still probably too infectious to give to humans. It's only partially attenuated, or weakened, for virulence," he added.
The work appears in the Journal of Clinical Investigation.
Porcelli said the researchers are working to make the vaccine safer by removing additional genes. He said they plan to test it in monkeys. He said if the results continue to be positive, human studies may be possible in two to three years.
"We're very excited because this is the first vaccine strain we've ever seen that is significantly better than BCG," said another researcher, William Jacobs of Albert Einstein College of Medicine and the Howard Hughes Medical Institute.
The TB organism infects roughly a third of the world's population. Most infections remain latent but can become active when the immune system is weakened, for example in people also infected by the virus that causes AIDS. About 10 million people worldwide have active cases of TB.
The existing BCG vaccine protects young children from tuberculosis, but does not do well at preventing the type of TB most adolescents and adults develop.
TB can be treated effectively with drugs in many cases, but the drugs have to be given daily for upward of six months, making treatment complicated and expensive. Many poorer parts of the world lack the medical infrastructure to deliver that kind of treatment, so many experts believe an effective vaccine could be a highly valuable tool in combating the disease.
Brain electrodes help man speak again
NEW YORK - He was beaten and left for dead one night in a robbery while walking home in 1999. His skull was crushed and his brain severely damaged. The doctor said if he pulled through at all, he'd be a vegetable for the rest of his life.
For six years, the man could not speak or eat.
On occasion he showed signs of awareness, and he moved his eyes or a thumb to communicate. His arms were useless. He was fed through a tube.
But researchers chose him for an experimental attempt to rev up his brain by placing electrodes in it. And here's how his mother describes the change in her son, now 38:
"My son can now eat, speak, watch a movie without falling asleep," she said Wednesday while choking back tears during a telephone news conference. "He can drink from a cup. He can express pain. He can cry and he can laugh.
"The most important part is he can say, `Mommy' and `Pop.' He can say, `I love you, Mommy' ... I still cry every time I see my son, but it's tears of joy."
The progress of the patient, who remains unidentified at the family's request, is described more formally in a report in Thursday's issue of the journal Nature.
Experts called the results encouraging but cautioned that the experimental treatment must be tried in more patients before its value can be assessed. The researchers are already proceeding with a larger study.
Before the electrodes were implanted, the man was in what doctors call a "minimally conscious state." That means he showed only occasional awareness of himself and his environment. In a coma or vegetative state, by contrast, patients show no outward signs of awareness.
There are no reliable statistics on how many Americans are in a minimally conscious state, but one estimate suggests 112,000 to 280,000. Doctors may try medications to improve their condition but no drugs have been firmly established as helpful.
The experimental treatment is called deep brain stimulation. It has been used for years in treating Parkinson's disease, although in this case the electrodes were implanted in slightly different places. The goal of the stimulation was to provide "drive" to areas of the brain that are critical for specific skills like speaking.
Similar stories of partial recovery from brain damage occasionally grab headlines, whether the improvement came from treatment or just out of the blue.
Terry Wallis of Arkansas lingered in a minimally conscious state for almost 20 years before he suddenly regained some ability to speak and move in 2003. In 2005, a former firefighter in Buffalo, N.Y., turned from being barely aware and almost mute for nearly a decade into a virtual chatterbox for 14 hours. His doctor had been trying a cocktail of drugs.
The man described in the Nature paper, despite his improvements, remains severely disabled in a rehabilitation facility for brain injury on the East Coast. (To preserve the man's anonymity, the researchers would not identify the facility or even reveal which state it is in).
He can't walk. While he has regained the ability to chew and swallow, he must be spoon-fed. He can demonstrate the motion of brushing his teeth, for example, but he can't actually do it. That's because tendons in his arms contracted after years of immobility, said study lead author Dr. Nicholas Schiff of Weill Cornell Medical College in New York.
The man doesn't initiate conversation but can reply to others, generally with one to three words, said Dr. Joseph Giacino, a co-lead author of the Nature study.
Several weeks ago, he recited the first half of the Pledge of Allegiance without assistance, said Giacino, of the JFK Johnson Rehabilitation Institute in Edison, N.J.
The man's electrodes are left on for 12 hours a day. He has continued to improve since the experiment formally ended in February 2006, the doctors said.
After the research was over, doctors started giving him the drug amantadine, which has shown some potential for treating people in a minimally conscious state. It's not clear whether amantadine can boost the effects of deep brain stimulation or vice versa, Giacino said.
Dr. James Bernat, a professor of neurology at Dartmouth Medical School who didn't participate in the new research, called the Nature report exciting and important. Further study is needed to sort out how many patients would respond and how to identify the minimally conscious patients with the best chance of being helped, he said.
He noted that a similar treatment did not help Terri Schiavo, the Florida woman in a vegetative state whose care triggered national controversy before her death in 2005. That's the typical outcome for electrical brain stimulation in vegetative states, he said.
Dr. Ross Zafonte of the University of Pittsburgh, who also was familiar with the study results, agreed that "we need to know more." He said the approach is "very interesting and holds great promise."
___
On the Net:
http://www.nature.com/nature
For six years, the man could not speak or eat.
On occasion he showed signs of awareness, and he moved his eyes or a thumb to communicate. His arms were useless. He was fed through a tube.
But researchers chose him for an experimental attempt to rev up his brain by placing electrodes in it. And here's how his mother describes the change in her son, now 38:
"My son can now eat, speak, watch a movie without falling asleep," she said Wednesday while choking back tears during a telephone news conference. "He can drink from a cup. He can express pain. He can cry and he can laugh.
"The most important part is he can say, `Mommy' and `Pop.' He can say, `I love you, Mommy' ... I still cry every time I see my son, but it's tears of joy."
The progress of the patient, who remains unidentified at the family's request, is described more formally in a report in Thursday's issue of the journal Nature.
Experts called the results encouraging but cautioned that the experimental treatment must be tried in more patients before its value can be assessed. The researchers are already proceeding with a larger study.
Before the electrodes were implanted, the man was in what doctors call a "minimally conscious state." That means he showed only occasional awareness of himself and his environment. In a coma or vegetative state, by contrast, patients show no outward signs of awareness.
There are no reliable statistics on how many Americans are in a minimally conscious state, but one estimate suggests 112,000 to 280,000. Doctors may try medications to improve their condition but no drugs have been firmly established as helpful.
The experimental treatment is called deep brain stimulation. It has been used for years in treating Parkinson's disease, although in this case the electrodes were implanted in slightly different places. The goal of the stimulation was to provide "drive" to areas of the brain that are critical for specific skills like speaking.
Similar stories of partial recovery from brain damage occasionally grab headlines, whether the improvement came from treatment or just out of the blue.
Terry Wallis of Arkansas lingered in a minimally conscious state for almost 20 years before he suddenly regained some ability to speak and move in 2003. In 2005, a former firefighter in Buffalo, N.Y., turned from being barely aware and almost mute for nearly a decade into a virtual chatterbox for 14 hours. His doctor had been trying a cocktail of drugs.
The man described in the Nature paper, despite his improvements, remains severely disabled in a rehabilitation facility for brain injury on the East Coast. (To preserve the man's anonymity, the researchers would not identify the facility or even reveal which state it is in).
He can't walk. While he has regained the ability to chew and swallow, he must be spoon-fed. He can demonstrate the motion of brushing his teeth, for example, but he can't actually do it. That's because tendons in his arms contracted after years of immobility, said study lead author Dr. Nicholas Schiff of Weill Cornell Medical College in New York.
The man doesn't initiate conversation but can reply to others, generally with one to three words, said Dr. Joseph Giacino, a co-lead author of the Nature study.
Several weeks ago, he recited the first half of the Pledge of Allegiance without assistance, said Giacino, of the JFK Johnson Rehabilitation Institute in Edison, N.J.
The man's electrodes are left on for 12 hours a day. He has continued to improve since the experiment formally ended in February 2006, the doctors said.
After the research was over, doctors started giving him the drug amantadine, which has shown some potential for treating people in a minimally conscious state. It's not clear whether amantadine can boost the effects of deep brain stimulation or vice versa, Giacino said.
Dr. James Bernat, a professor of neurology at Dartmouth Medical School who didn't participate in the new research, called the Nature report exciting and important. Further study is needed to sort out how many patients would respond and how to identify the minimally conscious patients with the best chance of being helped, he said.
He noted that a similar treatment did not help Terri Schiavo, the Florida woman in a vegetative state whose care triggered national controversy before her death in 2005. That's the typical outcome for electrical brain stimulation in vegetative states, he said.
Dr. Ross Zafonte of the University of Pittsburgh, who also was familiar with the study results, agreed that "we need to know more." He said the approach is "very interesting and holds great promise."
___
On the Net:
http://www.nature.com/nature
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