Archive for May, 2010

SEXUAL ACTIVITY DECLINES FOR HEART ATTACK PATIENTS NOT GETTING DOCTORS’ ADVICE

Friday, May 21st, 2010

WASHINGTON, May 21, 2010
Sexual activity declines in the year after heart attack for patients who don’t get instructions from their doctors about when it’s safe to resume sex, researchers reported at the American Heart Association’s 11th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.

Stacy Tessler Lindau, M.D.
Stacy Tessler Lindau, M.D.
Lead author of the study and
associate professor of obstetrics/
gynecology and medicine-
geriatrics at the University
of Chicago
Photo: sshvs.org

In a study of 1,184 male and 576 female acute heart attack patients, nearly half the men and about a third of women reported receiving discharge instructions on resuming sexual activity. Even fewer - less than 40 percent of men and less than 20 percent of women - talked about sex with their physicians in the year following their heart attack.

One year after heart attack, more than two thirds of the men reported some sexual activity, and about 40 percent of the women reported sexual activity. Men were 1.3 times and women 1.4 times more likely to report a loss of sexual activity after one year if they didn’t receive information on when to resume sexual activity.

“Sexuality is an important part of life throughout life, and most heart attack patients are sexually active” said Stacy Tessler Lindau, M.D., lead author of the study and associate professor of obstetrics/gynecology and medicine geriatrics at the University of Chicago. “For the most part, physicians just aren’t discussing this topic with their patients after a heart attack.”

Most participants were assessed at one month and again at one year following their heart attack regarding level of sexual activity both before and after heart attack. Researchers set up gender separate models to predict the frequency of sexual activity at one year following a heart attack in those who were sexually active prior to or since their heart attack. Male participants (average age 59 years) were more likely to be married than women participants (average age 61 years) and were more likely to be sexually active prior to the heart attack. Even after adjusting for these differences, patients who had been given instructions about resuming sexual activity at hospital discharge were more likely to engage in such activity over the following year.

The study was part of TRIUMPH (Translational Research Investigating Underlying Disparities in Recovery from Acute Myocardial Infarction: Patients’ Health Status). Participants were asked questions about their sexual activity prior to and after having a heart attack.

“As survival after a heart attack continues to improve, it is important to begin studying the outcomes of patients who survive; their symptoms, function and quality of life,” said John A. Spertus, M.D., M.P.H., Clinical Director of Outcomes Research at Saint Luke’s Mid America Heart Institute/UMKC and Principal Investigator of the TRIUMPH Study. “To date, few studies have examined whether patients who survive a heart attack resume sexual activity.”

“Little is known about what happens to patients’ sexuality and sexual function after a heart attack, particularly for women” Lindau said. “While most hospitals have a regimented process of presenting discharge information to patients after heart attack, the question of when it’s safe to resume sexual activity after heart attack is not always addressed.”

Even when it’s discussed, the researchers aren’t sure what’s being said. “We don’t yet know the content or value of the instructions patients are receiving,” she said

The consensus among physicians is that it’s safe to resume sexual activity after a heart attack once the patient feels better and is capable of performing moderate exercise.

“The likelihood of dying during sexual intercourse, even among people who have had a heart attack, is really small,” Lindau said.

Some physicians are reluctant to discuss sex with patients who are older, aren’t married or belong to a conservative religious group, she said. “But in the case of sexuality, stereotypes don’t work. Older patients may not be married but still have an intimate romantic partner.”

Physicians need to bring up the subject, even if it’s not part of a routine discharge check list, because “not raising the question of sexuality leaves the door closed.”

Noting their data are preliminary, Lindau said further study is required to determine what information the patients were given by their physicians, what patients need to know, and how to tailor information for patients so that they will feel free to ask questions and to seek help.

“Often physicians are focused on saving lives, and sexual health may not be valued as much as medications and other treatments to prevent further progression of their coronary disease,” she said. “Doctors need to be proactive and help patients recover their whole lives after heart attack. Physicians need to assess a patient’s sexual history to ensure all aspects of a patient’s physical and emotional well-being are addressed. This is an essential part of healthcare.”

>>>>>Read all the Heart News in our HeartVigor.com News Page.

CHOLESTEROL CRYSTALS INCITE INFLAMMATION IN CORONARY ARTERIES

Tuesday, May 18th, 2010

EAST LANSING, Mich. - MAY 18, 2010
Cholesterol crystals, known to be a catalyst for heart attacks and strokes, also cause cells to send out danger signals that can lead to the inflammation and hardening of arteries, according to a Michigan State University cardiologist.

George Abela
George Abela, chief of the
cardiology division in MSU’s
College of Human Medicine.
of Medicine
Photos:news.msu.edu
Cholesterol Crystals
The protruding elements seen in
the different slides are
cholesterol crystals. Those
elements are arising from within
the artery wall, causing tearing
and damage to the artery. The
colors have been added for
enhancement and imagery.

The discovery by George Abela, chief of the cardiology division in MSU’s College of Human Medicine, and a team of researchers provides new insights into how arteries harden - a process called atherosclerosis - and gives hope for new and early treatments of cardiovascular disease.

The findings are published in the most recent edition of the journal Nature.

Past research has shown that as cholesterol builds up along the wall of an artery, it crystallizes from a liquid to a solid state and expands, said Abela, who has been studying cholesterol crystals for nearly a decade. As the crystals expand, they can disrupt plaque and cause clotting, leading to cardiac attacks. That research also was recently highlighted recently in the Journal of Clinical Lipidology.

In a new discovery, Abela and the team - while looking at causes of inflammation during atherosclerosis in mice - found that the once cholesterol crystals form in the arterial wall, they activate a biomarker called NLRP3 that induces inflammation.

“What we have found now, at the cellular level, is that the crystals are an early cause rather than a late consequence of inflammation,” Abela said.

The discovery could lead to new treatments for heart disease.

“Since cholesterol crystals form very early in the process of heart disease, with great potential to aggravate atherosclerosis, we can target them early on,” Abela said. “We can target new therapies by reducing cholesterol crystal deposits early on or use an inhibitor to block the inflammatory biomarker.”

Abela added that the biomarker activated by the crystals could be a better indicator of potential cardiovascular disease than others, such as serum cholesterol, or the amount of cholesterol found in the bloodstream.

“Now we treat atherosclerosis on the systematic level; with this discovery we can also treat it the cellular level,” he said.

>>>>>Read all the heart news in our HeartVigor.com News Page.

MALE OBESITY LINKED TO LOW TESTOSTERONE LEVELS

Monday, May 3rd, 2010

BUFFALO, N.Y. - MAY 3, 2010
Obesity, a condition linked to heart disease and diabetes, now appears to be associated with another health problem, but one that affects men only - low testosterone levels.

Sandeep Dhindsa, MD
Sandeep Dhindsa, MD is an
endocrinology specialist in
the UB Department of Medicine
of Medicine
Photo:diabetes-
endocrinologycenterofwny.com

Results of a study published online ahead of print in the journal Diabetes Care, conducted by University at Buffalo endocrinologists, showed that 40 percent of obese participants involved in the Hypogonadism in Males (HIM) study had lower than normal testosterone readings.

The percentage rose to 50 percent among obese men with diabetes. Results also revealed that as body mass index (BMI) - a relationship of weight to height - increased, testosterone levels fell.

“The effect of diabetes on lowering testosterone levels was similar to that of a weight gain of approximately 20 pounds,” says Sandeep Dhindsa, MD, an endocrinology specialist in the UB Department of Medicine and first author on the study.

“In view of the fact that almost one-third of the U.S. is obese, these observations have profound pathophysiological, clinical, epidemiological and public health implications.”

This is the largest analysis of the association between obesity and low testosterone, and the first to compare prevalence of low testosterone with obesity and diabetes separately and together. The study shows that obesity and diabetes may exert independent influences on testosterone concentrations.

“We published a report in 2004 on the high prevalence of low testosterone levels in men with type 2 diabetes, and multiple studies all over the world have confirmed the association of low testosterone with diabetes,” Dhindsa notes.

“The Endocrine Society now recommends that all men with type 2 diabetes should have their testosterone levels measured. Our new study shows that obese men also have a very high prevalence of low testosterone levels, so physicians should consider screening obese non diabetic men, as well, for low testosterone.”

The HIM study was funded by Solvay Pharmaceuticals Inc., and was conducted from November 2003 to February 2004 in 95 primary care practices throughout the U.S. The study involved 2,165 men 45 years or older who provided blood samples for analysis of testosterone concentrations.

UB researchers excluded participants from the full study who had no BMI data or were on certain drugs that can affect testosterone levels, providing a study population of 1,849 men - 398 with diabetes and 1,451 non diabetics.

“With the rising prevalence of obesity in the U.S. and the rest of the world,” says Paresh Dandona, MD, head of the Division of Endocrinology, Diabetes and Metabolism at UB and Kaleida Health, and senior author of the study, “it is imperative that the prevalence of low testosterone levels in obese men be defined. In addition, the magnitude of the contribution of obesity to subnormal testosterone needs to be quantified.

“We hypothesized that obese men are more likely to have low testosterone than non-obese men, and that we would find more low testosterone levels in men with diabetes than in men without diabetes, both obese and non obese.”

Results confirmed these hypotheses, showing a 40 percent higher prevalence of low testosterone in obese men compared to the non obese participants. Men with diabetes, whether obese or not, showed lower levels of testosterone than non diabetic men across all weight categories. Testosterone levels decreased significantly in both diabetic and non diabetic men as BMI increased.

“In view of the increasing prevalence of obesity, even in younger populations, it would be important to conduct a similar study in the men at the prime of their reproductive years,” he says.

UB endocrinologists published a study in Diabetes Care in 2008 showing that more than 50 percent of men between 18 and 35 years old with type 2 diabetes had lower than normal testosterone levels.

“In view of the high rates of subnormal testosterone in patients with obesity or diabetes, testosterone concentrations should be measured regularly in these populations, especially when these conditions occur together,” says Dandona.

>>>>>Read all the latest in our HeartVigor.com News Pages.

PROBIOTICS HELP EXTREMELY PREMATURE INFANTS GAIN WEIGHT

Saturday, May 1st, 2010

Extremely low birthweight infants (ELBW) who received feedings supplemented with probiotics had better weight gain than infants who were not given the supplements, according to a randomized, controlled, double blind study to be presented Saturday, May 1 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Mohamad Al-Hosni, MD
Dr. Al-Hosni is an Assistant
Professor of Pediatrics at
Saint Louis University School
of Medicine
Photo:wwwic.ssmhc.com

Dr. Al-Hosni is an Assistant Professor of Pediatrics at Saint Louis University School of Medicine. Probiotics, which means “for life” in Latin, are healthy, live organism supplements that provide benefit to the host. Their effect on digestive health and immune function has been studied. However, the safety and efficacy of probiotic supplementation in ELBW infants has not been explored thoroughly.

In this study, Mohamad Al-Hosni, MD, and colleagues from three medical centers, in collaboration with Vermont Oxford Network, evaluated the effect of supplementing enteral (tube) feedings with probiotics in extremely premature infants who weighed 2 pounds, 2 ounces or less. They hypothesized that infants who received probiotic supplemented feedings would tolerate larger volumes of feeding per day, grow faster and require fewer days of antimicrobial treatment than those in the control group.

Fifty infants received 500 million colony forming units (CFU) of Lactobacillus rhamnosus GG and 500 million CFU of Bifidobacterium infantis in enteral feedings once a day until discharge or 34 weeks postmenstrual age. Fifty one infants received feedings with no probiotics.

Results showed superior weight gain in infants who received the probiotics even though the average daily volume of their feedings was less than infants in the control group. There were no statistically significant differences in other complications of prematurity such as sepsis or necrotizing enterocolitis. In addition, no side effects were seen as a result of probiotic supplementation, according to Dr. Mohamad Al-Hosni, an assistant professor of pediatrics at Saint Louis University School of Medicine in the division of neonatal perinatal medicine at SSM Cardinal Glennon Children’s Medical Center.

“These findings strongly suggest that probiotic supplementation to enteral feedings plays a major role in feeding tolerance and nutrient absorption,” he said. “Improved tolerance of feedings and nutrient absorption lead to better weight gain in this extremely premature infant group.”

Dr. Al-Hosni concluded that larger clinical trials are needed to demonstrate the safety and efficacy of probiotic supplementation to enteral feeding in this group of infants.

>>>>>Read all the latest in our HeartVigor.com News Pages.