Women typically get heart disease much later than men, but not if they smoke, researchers said Tuesday.
In fact, women who smoke have heart attacks more than a dozen years earlier than women who don't smoke, Norwegian doctors reported in a study presented to the European Society of Cardiology. For men, the gap is not so dramatic; male smokers have heart attacks about six years earlier than men who don't smoke.
"This is not a minor difference," said Dr. Silvia Priori, a cardiologist at the Scientific Institute in Pavia, Italy. "Women need to realize they are losing much more than men when they smoke," she said. Priori was not connected to the research.
Dr. Morten Grundtvig and colleagues from the Innlandet Hospital Trust in Lillehammer, Norway, based their study on data from 1,784 patients admitted for a first heart attack at a hospital in Lillehammer.
Their study found that the men on average had their first heart attack at age 72 if they didn't smoke, and at 64 if they did. Women in the study had their first heart attack at age 81 if they didn't smoke, and at age 66 if they did.
That works out to eight and 15 years, respectively, for men and women. After adjusting for other heart risk factors like blood pressure, cholesterol and diabetes, researchers found that the difference for men was about six years for women about 14 years.
Previous studies looking at a possible gender difference have been inconclusive.
Doctors have long suspected that female hormones protect women against heart disease. Estrogen is thought to raise the levels of good cholesterol as well as enabling blood vessel walls to relax more easily, thus lowering the chances of a blockage.
Grundtvig said that smoking might make women go through menopause earlier, leaving them less protected against a heart attack. With rising rates of smoking in women - compared with falling rates in men - Grundtvig said that doctors expect to see increased heart disease in women.
"Smoking might erase the natural advantage that women have," said Dr. Robert Harrington, a professor of medicine at Duke University and spokesman for the American College of Cardiology.
Doctors aren't yet sure if other cardiac risk factors like cholesterol and obesity also affect women differently.
"The difference in how smoking affects women and men is profound," Harrington said. "Unless women don't smoke or quit, they risk ending up with the same terrible diseases as men, only at a much earlier age."
Sunday, August 31, 2008
Saturday, August 30, 2008
Gene domino effect behind brain, pancreatic tumors
Scientists have mapped the cascade of genetic changes that turn normal cells in the brain and pancreas into two of the most lethal cancers. The result points to a new approach for fighting tumors and maybe even catching them sooner. Genes blamed for one person's brain tumor were different from the culprits for the next patient, making the puzzle of cancer genetics even more complicated.
But Friday's research also found that clusters of seemingly disparate genes all work along the same pathways. So instead of today's hunt for drugs that target a single gene, the idea is to target entire pathways that most patients share. Think of delivering the mail to a single box at the end of the cul-de-sac instead of at every doorstep.
The three studies, published in the journals Science and Nature, mark a milestone in cancer genetics.
"This is the next wave," said Dr. Phillip Febbo of Duke University's Institute for Genome Sciences and Policy, who was not involved with the new research. "What's really important is that finding those common elements within the landscape suggests there are therapeutic interventions that can help the whole group."
Despite 30 years of laborious work, scientists until now have found only a fraction of the genetic alterations required to cause any of the 200 diseases that collectively are called cancer. Different tumors require a different domino effect of genetic changes to arise, and to determine their severity and even which treatments will work.
The new maps do not include just mutated genes. They cite missing ones, extra ones, and overactive or underactive ones, too, in the most comprehensive look ever at human tumors.
Teams led by Johns Hopkins University examined more than 20,000 genes in tumors taken from 24 pancreatic cancer patients and 22 patients with the most dangerous brain tumor, called glioblastoma multiforme. Separately, The Cancer Genome Atlas project - a government-funded network of 18 medical centers - analyzed 600 genes in glioblastomas from 206 patients.
The Hopkins teams found hundreds of genetic changes, including a particularly intriguing gene named IDH1. Twelve percent of glioblastoma patients, mostly young ones, harbored a mutated version that brought longer survival: a median of 3.8 years compared with the 1.1 years for patients without the mutation.
If additional study proves that effect, doctors soon might use an IDH1 test to help determine prognosis, said Hopkins' Dr. Victor Velculescu, who led the glioblastoma work. If so, the next question is whether certain drugs work better in those patients as well.
The bigger discovery involved cancer's genetic chaos. No tumors were identical. The typical pancreatic cancer contained 63 genetic alterations and the average brain tumor 60, Hopkins researchers reported in Science.
Fortunately, "genes don't work alone," said Hopkin's Dr. Kenneth Kinzler, who led the pancreatic work. Figure out which genes cluster in which pathways and "a simpler picture emerges."
The Hopkins team identified 12 core pathways that were abnormal in most pancreatic tumors.
In Nature, The Cancer Genome Atlas researchers reported three core pathways at work in most glioblastomas.
The pathways do different things. Some allow damaged DNA to escape repair. Some switched off protective factors meant to suppress tumors.
Finding drugs that block those pathways will not be easy, said Dr. Bert Vogelstein of Hopkins and the Howard Hughes Medical Institute, who oversaw the research. They also may cause more side effects than current "targeted therapies" that work against only a specific gene defect.
But companies already are researching drugs to block a particular enzyme pathway implicated in the studies.
Also, pathway blockers should work in larger groups of patients, Vogelstein said. One particular pancreatic cancer pathway contains a variety of genes mutated in only a few people, but regardless of which gene ran amok, the whole pathway was broken in every tumor studied.
"Even though it sounds complex, it's actually allowing us to simplify the complex into pathways that will allow us, I think, to truly understand cancer for the first time and take a much more rational approach to treatment," said Dr. Anna Barker of the National Cancer Institute, who co-directs the cancer atlas project. "I'm more optimistic."
Moreover, the work suggests possible ways to catch cancer earlier, by tracing mutant DNA floating through the bloodstream well before tumors themselves start to spread, Vogelstein added. "I don't think that's any longer science fiction."
But Friday's research also found that clusters of seemingly disparate genes all work along the same pathways. So instead of today's hunt for drugs that target a single gene, the idea is to target entire pathways that most patients share. Think of delivering the mail to a single box at the end of the cul-de-sac instead of at every doorstep.
The three studies, published in the journals Science and Nature, mark a milestone in cancer genetics.
"This is the next wave," said Dr. Phillip Febbo of Duke University's Institute for Genome Sciences and Policy, who was not involved with the new research. "What's really important is that finding those common elements within the landscape suggests there are therapeutic interventions that can help the whole group."
Despite 30 years of laborious work, scientists until now have found only a fraction of the genetic alterations required to cause any of the 200 diseases that collectively are called cancer. Different tumors require a different domino effect of genetic changes to arise, and to determine their severity and even which treatments will work.
The new maps do not include just mutated genes. They cite missing ones, extra ones, and overactive or underactive ones, too, in the most comprehensive look ever at human tumors.
Teams led by Johns Hopkins University examined more than 20,000 genes in tumors taken from 24 pancreatic cancer patients and 22 patients with the most dangerous brain tumor, called glioblastoma multiforme. Separately, The Cancer Genome Atlas project - a government-funded network of 18 medical centers - analyzed 600 genes in glioblastomas from 206 patients.
The Hopkins teams found hundreds of genetic changes, including a particularly intriguing gene named IDH1. Twelve percent of glioblastoma patients, mostly young ones, harbored a mutated version that brought longer survival: a median of 3.8 years compared with the 1.1 years for patients without the mutation.
If additional study proves that effect, doctors soon might use an IDH1 test to help determine prognosis, said Hopkins' Dr. Victor Velculescu, who led the glioblastoma work. If so, the next question is whether certain drugs work better in those patients as well.
The bigger discovery involved cancer's genetic chaos. No tumors were identical. The typical pancreatic cancer contained 63 genetic alterations and the average brain tumor 60, Hopkins researchers reported in Science.
Fortunately, "genes don't work alone," said Hopkin's Dr. Kenneth Kinzler, who led the pancreatic work. Figure out which genes cluster in which pathways and "a simpler picture emerges."
The Hopkins team identified 12 core pathways that were abnormal in most pancreatic tumors.
In Nature, The Cancer Genome Atlas researchers reported three core pathways at work in most glioblastomas.
The pathways do different things. Some allow damaged DNA to escape repair. Some switched off protective factors meant to suppress tumors.
Finding drugs that block those pathways will not be easy, said Dr. Bert Vogelstein of Hopkins and the Howard Hughes Medical Institute, who oversaw the research. They also may cause more side effects than current "targeted therapies" that work against only a specific gene defect.
But companies already are researching drugs to block a particular enzyme pathway implicated in the studies.
Also, pathway blockers should work in larger groups of patients, Vogelstein said. One particular pancreatic cancer pathway contains a variety of genes mutated in only a few people, but regardless of which gene ran amok, the whole pathway was broken in every tumor studied.
"Even though it sounds complex, it's actually allowing us to simplify the complex into pathways that will allow us, I think, to truly understand cancer for the first time and take a much more rational approach to treatment," said Dr. Anna Barker of the National Cancer Institute, who co-directs the cancer atlas project. "I'm more optimistic."
Moreover, the work suggests possible ways to catch cancer earlier, by tracing mutant DNA floating through the bloodstream well before tumors themselves start to spread, Vogelstein added. "I don't think that's any longer science fiction."
Friday, August 29, 2008
Exercise can help memory
Adding even a small amount of exercise to a person's daily routine can reduce the risk of developing Alzheimer's disease, according to a study published in Wednesday's Journal of the American Medical Association.
The study, by Australian researchers, showed that six months of physical activity -- averaging about 20 minutes a day -- in volunteers 50 and older modestly improved memory and cognition.
"This is the first time anybody has shown that a modest exercise program seemed to slow the rate of Alzheimer's disease," said Dr. Eric Larson, executive director of the Seattle-based Group Health Center for Health Studies, who wrote an editorial accompanying the study.
"In the United States, pharmaceutical direct-to-consumer advertising has sensitized patients and the public to using cholinesterase inhibitors for Alzheimer's disease," Larson wrote. "This illustrates the appeal of 'doing something -- anything' that might help prevent a dreaded disease, even if its value is minimal. Promoting habitual exercise for aging patients seems more worthy."
The researchers randomly engaged 170 volunteers in 24 weeks of physical activity, including walking and swimming, and compared them with a similar group that didn't exercise. The volunteers all reported having memory problems, but none suffered from dementia. They each wore a pedometer and kept a diary of their physical activity.
Participants were asked to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions. They averaged 142 extra minutes of exercise.
Researchers used an 11-test Alzheimer's scale to assess memory, language and skill application over 18 months. Scores range from zero to 70 -- the higher the number the more severe the impairment.
By the end of the study, participants in the exercise group had better scores and less delayed recall. The exercisers also had lower dementia scores.
The study showed an average improvement of 1.3 points on the Alzheimer's scale after six months of enhanced exercise, and 0.69 points after 18 months. That's a tiny boost, researchers admit, but "potentially important when one considers the small amount of physical activity undertaken by participants of the study."
The results are encouraging, said Nancy Dapper, executive director of the Alzheimer's Association's Western and Central Washington chapter.
"With Alzheimer's we don't often have a lot to turn to, and with this study, the amount of exercise is manageable for most people," she said. "The studies are building on each other about the benefits of exercise to the brain.
"The next question might be: Is it worthy to do more studies looking at more vigorous exercise or different types of exercise?"
Researchers don't yet know why exercise makes a difference, but the added benefits can go beyond brain improvements.
Larson said one explanation could be that exercise improves blood flow to the brain. That allows people to better handle the stress that can damage parts of the brain.
"If you ask doctors what disease they fear the most, it's Alzheimer's," said Larson, who writes exercise prescriptions for some of his patients to prod them into getting needed workouts.
"This is a potential motivator to our society to design more walkable and bikeable communities," he said of the study. "It gives people yet another reason to exercise."
The study, by Australian researchers, showed that six months of physical activity -- averaging about 20 minutes a day -- in volunteers 50 and older modestly improved memory and cognition.
"This is the first time anybody has shown that a modest exercise program seemed to slow the rate of Alzheimer's disease," said Dr. Eric Larson, executive director of the Seattle-based Group Health Center for Health Studies, who wrote an editorial accompanying the study.
"In the United States, pharmaceutical direct-to-consumer advertising has sensitized patients and the public to using cholinesterase inhibitors for Alzheimer's disease," Larson wrote. "This illustrates the appeal of 'doing something -- anything' that might help prevent a dreaded disease, even if its value is minimal. Promoting habitual exercise for aging patients seems more worthy."
The researchers randomly engaged 170 volunteers in 24 weeks of physical activity, including walking and swimming, and compared them with a similar group that didn't exercise. The volunteers all reported having memory problems, but none suffered from dementia. They each wore a pedometer and kept a diary of their physical activity.
Participants were asked to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions. They averaged 142 extra minutes of exercise.
Researchers used an 11-test Alzheimer's scale to assess memory, language and skill application over 18 months. Scores range from zero to 70 -- the higher the number the more severe the impairment.
By the end of the study, participants in the exercise group had better scores and less delayed recall. The exercisers also had lower dementia scores.
The study showed an average improvement of 1.3 points on the Alzheimer's scale after six months of enhanced exercise, and 0.69 points after 18 months. That's a tiny boost, researchers admit, but "potentially important when one considers the small amount of physical activity undertaken by participants of the study."
The results are encouraging, said Nancy Dapper, executive director of the Alzheimer's Association's Western and Central Washington chapter.
"With Alzheimer's we don't often have a lot to turn to, and with this study, the amount of exercise is manageable for most people," she said. "The studies are building on each other about the benefits of exercise to the brain.
"The next question might be: Is it worthy to do more studies looking at more vigorous exercise or different types of exercise?"
Researchers don't yet know why exercise makes a difference, but the added benefits can go beyond brain improvements.
Larson said one explanation could be that exercise improves blood flow to the brain. That allows people to better handle the stress that can damage parts of the brain.
"If you ask doctors what disease they fear the most, it's Alzheimer's," said Larson, who writes exercise prescriptions for some of his patients to prod them into getting needed workouts.
"This is a potential motivator to our society to design more walkable and bikeable communities," he said of the study. "It gives people yet another reason to exercise."
Thursday, August 28, 2008
Heart defibrillator shock can signal more trouble
A lifesaving shock from an implanted heart defibrillator provides relief that a crisis was avoided, but new research suggests it can also be a sign that more trouble is ahead.
A study found that heart failure patients were far more likely to die within four years after their defibrillator zapped the heart into beating normally than those who got no shock.
Experts said patients should promptly tell their doctors if their defibrillator triggers. And doctors should check to see if their patients' condition has worsened and whether tests or medication changes are needed.
"We need to think about everything else we possibly could do to make them as healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the University of Washington.
The findings are in Thursday's New England Journal of Medicine, along with another study that concluded that having an implanted defibrillator doesn't appear to diminish one's quality of life.
About 234,800 North Americans have defibrillators, which cost between $25,000 and $35,000. The devices, about the size of a stopwatch, are designed to correct dangerously high or erratic heartbeats in the lower, pumping chambers of the heart.
Previous research found that the devices cut the risk of death by 23 percent. The new reports come from that same study of 2,500 heart failure patients - their weakened hearts didn't pump efficiently - who hadn't yet had a life-threatening irregular heartbeat.
The new government-funded reports show that a defibrillator prolongs "survival in patients with heart failure, with relatively little compromise in the quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University in Hamilton, Ontario, in a journal editorial. But they added: "It is somewhat disturbing to realize that actually receiving a shock is such an important predictor of death."
In the study, about a third of the 811 patients with defibrillators were shocked during nearly four years of follow-up. Data recorded by the devices shows whether the shock corrected a life-threatening irregularity or was inappropriately fired by another problem, such as an abnormal rhythm in the heart's upper chambers.
The researchers found that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. Even people who didn't seem to need a shock but got one had double the risk of dying.
Dr. N.A. Mark Estes, president of the Heart Rhythm Society, noted that the defibrillators used in the study are a generation-old, and that newer devices can often correct a high heartbeat through painless pacing techniques, before a shock would be needed.
"The frequency of shocks would be considerably less with contemporary devices," said Estes, of Tufts Medical Center in Boston. He had no role in the studies but has been involved in others.
For the quality of life study, participants were questioned four times over 2 1/2 years about their activities and well-being to see how the defibrillator was affecting their lives. There was no difference between the groups treated with defibrillators, medication or dummy pills, the researchers said.
"We found no evidence that the patients who got the defibrillator were feeling any worse for having received that therapy," said Dr. Daniel Mark, lead author of the study from Duke University Medical Center.
A patient at Duke, John McKinnon, said he was initially reluctant to get a defibrillator about two years but has had no concerns since. Months ago, the 65-year-old pastor got a shock, which he described as a strong kick. Since then he's had a procedure to treat an abnormal heartbeat.
"I'm getting my energy back, doing some walking, getting some exercise," said McKinnon.
Medtronic Inc. provided the defibrillators used in the research and Wyeth provided the medicine. Many of the researchers and the editorial writers have received lecture fees or grants from makers of defibrillators.
A study found that heart failure patients were far more likely to die within four years after their defibrillator zapped the heart into beating normally than those who got no shock.
Experts said patients should promptly tell their doctors if their defibrillator triggers. And doctors should check to see if their patients' condition has worsened and whether tests or medication changes are needed.
"We need to think about everything else we possibly could do to make them as healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the University of Washington.
The findings are in Thursday's New England Journal of Medicine, along with another study that concluded that having an implanted defibrillator doesn't appear to diminish one's quality of life.
About 234,800 North Americans have defibrillators, which cost between $25,000 and $35,000. The devices, about the size of a stopwatch, are designed to correct dangerously high or erratic heartbeats in the lower, pumping chambers of the heart.
Previous research found that the devices cut the risk of death by 23 percent. The new reports come from that same study of 2,500 heart failure patients - their weakened hearts didn't pump efficiently - who hadn't yet had a life-threatening irregular heartbeat.
The new government-funded reports show that a defibrillator prolongs "survival in patients with heart failure, with relatively little compromise in the quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University in Hamilton, Ontario, in a journal editorial. But they added: "It is somewhat disturbing to realize that actually receiving a shock is such an important predictor of death."
In the study, about a third of the 811 patients with defibrillators were shocked during nearly four years of follow-up. Data recorded by the devices shows whether the shock corrected a life-threatening irregularity or was inappropriately fired by another problem, such as an abnormal rhythm in the heart's upper chambers.
The researchers found that those who needed a shock were more than five times more likely to die over the next four years than those who didn't require one. Even people who didn't seem to need a shock but got one had double the risk of dying.
Dr. N.A. Mark Estes, president of the Heart Rhythm Society, noted that the defibrillators used in the study are a generation-old, and that newer devices can often correct a high heartbeat through painless pacing techniques, before a shock would be needed.
"The frequency of shocks would be considerably less with contemporary devices," said Estes, of Tufts Medical Center in Boston. He had no role in the studies but has been involved in others.
For the quality of life study, participants were questioned four times over 2 1/2 years about their activities and well-being to see how the defibrillator was affecting their lives. There was no difference between the groups treated with defibrillators, medication or dummy pills, the researchers said.
"We found no evidence that the patients who got the defibrillator were feeling any worse for having received that therapy," said Dr. Daniel Mark, lead author of the study from Duke University Medical Center.
A patient at Duke, John McKinnon, said he was initially reluctant to get a defibrillator about two years but has had no concerns since. Months ago, the 65-year-old pastor got a shock, which he described as a strong kick. Since then he's had a procedure to treat an abnormal heartbeat.
"I'm getting my energy back, doing some walking, getting some exercise," said McKinnon.
Medtronic Inc. provided the defibrillators used in the research and Wyeth provided the medicine. Many of the researchers and the editorial writers have received lecture fees or grants from makers of defibrillators.
Wednesday, August 27, 2008
Check your Balance
There are times in your life when feeling a little off-balance may actually be a good thing. Take it from the experts.
Although there are some changes you can't avoid as you get older, including deterioration of your hearing, vision and coordination, research suggests that it's worth taking steps — even risking a few missteps — to slow the decline in your balance.
Loss of balance makes us vulnerable to falls, which can be dangerous at any age but is the fifth-leading cause of death for people 65 and older, according to the Centers for Disease Control and Prevention.
The CDC makes a number of recommendations to prevent falls, including exercising regularly to maintain muscle and getting enough vitamin D and calcium to preserve bone strength.
But a growing number of physicians, physical therapists and personal trainers go further, advocating exercises designed to challenge the complex system of reflexes that governs our stability and spatial orientation.
And, as Roger Yasin, a personal trainer in Arlington, Va., puts it, it's smart for younger people to start doing these exercises.
Yasin said many of his clients are surprised to find out how their balance declines over time, and they often underestimate how important balance is to navigating the hazards in their daily lives, from escalators to uneven sidewalks and grassy hills.
"Many people don't think of balance when they think of personal training; they think of diet and weight loss, or they want to get ready for a wedding or reunion."
Whether you're preparing for an event or doing your regular workout routine, Yasin and others recommend including exercises that address your balance.
Doing so has the added advantage of helping you lose weight. "Since you are trying to stabilize your body, you're using multiple muscle groups and can burn so many more calories," he said.
Yasin said everyone should start by balancing on the floor with one foot, before progressing to challenging equipment.
The following are a few of the many products aimed at different levels of fitness and expertise. Consult your trainer or doctor before choosing one that's right for you.
Balance pads look like thick gymnastics mats but feel much softer. The feeling of instability created by the pad's foam surface increases as the user puts more weight on it. It can be used for rehabilitation, exercise and coordination training. Performing lunges, push-ups or sit-ups on a balance pad improves overall strength and stability. By stacking two pads on top of one another, the user can create greater instability for a tougher workout.
Bosu ball. The Bosu, whose name stands for "Both Sides Utilized," resembles half a ball, with one flat and one domed side; it can be used for cardio, balance-building workouts or yoga. Users can sit, stand or squat on the curved side and sit or try push-ups on the flat side, all while trying to maintain balance as the body shifts to compensate for the movement of the ball.
Dyna-Disc. Yasin says the squishy surface of this circular, air-filled mat makes his clients feel as if they're stepping on a deflated football. People of all ages can sit, stand or lie on the disks to improve posture and balance in the lower body. The Dyna-Disc is made from the same material as a gym ball but is more stable since it can't roll away. It comes in different sizes suitable for a variety of exercises. Users can perform curls or other moves standing on the disk to strengthen core muscles. They can change the inflation level of the disk or stand with one under each foot to increase exercise difficulty.
Bongo board. This skateboardlike board is the most difficult of these products to use. It's designed to improve coordination by challenging the user to keep the board stable over a rolling wheel. The Bongo board is for more-advanced users and can also be used for push-ups to strengthen core muscles.
Other products are being created for people whose balance has decreased, whether through age or illness, and are geared toward preventing falls.
Insoles inspired by NASA technology that help astronauts keep their balance in space use sensors to record information about a person's ability to balance. Erez Liebermann, a graduate student at the Harvard-MIT Division of Health Sciences and Technology, began working on the iShoe insole as a NASA intern; it could be available in 18 months and cost about $100, according to the division's Web site.
Another product in development is the vibrating insole, or "noise-enhanced sensory function." Its inventor, Jim Collins, says it is intended to help elderly people detect changes in their environment, increase sensitivity to their surroundings and improve their balance. Collins said the insole is beginning the process of winning approval from the Food and Drug Administration.
If you don't frequent the gym but would still like to avoid falls, Scott McCredie, author of "Balance: In Search of the Lost Sense," says you don't need gadgets to improve your stability or core strength.
"All you need to do is stand on one leg in various poses, and you can do that anywhere," McCredie said, whether "waiting for the bus or brushing your teeth in the bathroom."
Physical therapist Kristine Legters takes this low-tech approach by incorporating balance training into her clients' everyday lives.
"Standing on a pillow, walking on grass as opposed to concrete, or looking around and moving your head while walking as opposed to looking straight challenges and improves your balance," said Legters, who works in Pennsylvania.
The takeaway message is clear: To maintain your stability as you get older, you need to throw yourself off-balance once in a while.
Although there are some changes you can't avoid as you get older, including deterioration of your hearing, vision and coordination, research suggests that it's worth taking steps — even risking a few missteps — to slow the decline in your balance.
Loss of balance makes us vulnerable to falls, which can be dangerous at any age but is the fifth-leading cause of death for people 65 and older, according to the Centers for Disease Control and Prevention.
The CDC makes a number of recommendations to prevent falls, including exercising regularly to maintain muscle and getting enough vitamin D and calcium to preserve bone strength.
But a growing number of physicians, physical therapists and personal trainers go further, advocating exercises designed to challenge the complex system of reflexes that governs our stability and spatial orientation.
And, as Roger Yasin, a personal trainer in Arlington, Va., puts it, it's smart for younger people to start doing these exercises.
Yasin said many of his clients are surprised to find out how their balance declines over time, and they often underestimate how important balance is to navigating the hazards in their daily lives, from escalators to uneven sidewalks and grassy hills.
"Many people don't think of balance when they think of personal training; they think of diet and weight loss, or they want to get ready for a wedding or reunion."
Whether you're preparing for an event or doing your regular workout routine, Yasin and others recommend including exercises that address your balance.
Doing so has the added advantage of helping you lose weight. "Since you are trying to stabilize your body, you're using multiple muscle groups and can burn so many more calories," he said.
Yasin said everyone should start by balancing on the floor with one foot, before progressing to challenging equipment.
The following are a few of the many products aimed at different levels of fitness and expertise. Consult your trainer or doctor before choosing one that's right for you.
Balance pads look like thick gymnastics mats but feel much softer. The feeling of instability created by the pad's foam surface increases as the user puts more weight on it. It can be used for rehabilitation, exercise and coordination training. Performing lunges, push-ups or sit-ups on a balance pad improves overall strength and stability. By stacking two pads on top of one another, the user can create greater instability for a tougher workout.
Bosu ball. The Bosu, whose name stands for "Both Sides Utilized," resembles half a ball, with one flat and one domed side; it can be used for cardio, balance-building workouts or yoga. Users can sit, stand or squat on the curved side and sit or try push-ups on the flat side, all while trying to maintain balance as the body shifts to compensate for the movement of the ball.
Dyna-Disc. Yasin says the squishy surface of this circular, air-filled mat makes his clients feel as if they're stepping on a deflated football. People of all ages can sit, stand or lie on the disks to improve posture and balance in the lower body. The Dyna-Disc is made from the same material as a gym ball but is more stable since it can't roll away. It comes in different sizes suitable for a variety of exercises. Users can perform curls or other moves standing on the disk to strengthen core muscles. They can change the inflation level of the disk or stand with one under each foot to increase exercise difficulty.
Bongo board. This skateboardlike board is the most difficult of these products to use. It's designed to improve coordination by challenging the user to keep the board stable over a rolling wheel. The Bongo board is for more-advanced users and can also be used for push-ups to strengthen core muscles.
Other products are being created for people whose balance has decreased, whether through age or illness, and are geared toward preventing falls.
Insoles inspired by NASA technology that help astronauts keep their balance in space use sensors to record information about a person's ability to balance. Erez Liebermann, a graduate student at the Harvard-MIT Division of Health Sciences and Technology, began working on the iShoe insole as a NASA intern; it could be available in 18 months and cost about $100, according to the division's Web site.
Another product in development is the vibrating insole, or "noise-enhanced sensory function." Its inventor, Jim Collins, says it is intended to help elderly people detect changes in their environment, increase sensitivity to their surroundings and improve their balance. Collins said the insole is beginning the process of winning approval from the Food and Drug Administration.
If you don't frequent the gym but would still like to avoid falls, Scott McCredie, author of "Balance: In Search of the Lost Sense," says you don't need gadgets to improve your stability or core strength.
"All you need to do is stand on one leg in various poses, and you can do that anywhere," McCredie said, whether "waiting for the bus or brushing your teeth in the bathroom."
Physical therapist Kristine Legters takes this low-tech approach by incorporating balance training into her clients' everyday lives.
"Standing on a pillow, walking on grass as opposed to concrete, or looking around and moving your head while walking as opposed to looking straight challenges and improves your balance," said Legters, who works in Pennsylvania.
The takeaway message is clear: To maintain your stability as you get older, you need to throw yourself off-balance once in a while.
Tuesday, August 26, 2008
Does Cholesterol Drug Increase Chance of Cancer?
Federal drug-safety regulators said Thursday they are investigating whether the cholesterol-lowering drug Vytorin can increase patients' risk of developing cancer.
However, Food and Drug Administration (FDA) officials said patients should not stop taking Vytorin, because the evidence of a cancer link is unclear. While one recent clinical trial indicated higher rates of cancer for patients taking the medication, two current studies have shown no increased risk, agency officials said.
Meanwhile, senior lawmakers in Congress demanded data on the clinical trial that indicated a cancer risk.
Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia, has been heavily promoted as a novel way to reduce cholesterol. Zocor, a statin, reduces the amount of cholesterol produced by the liver. Zetia limits the cholesterol absorbed through the digestive system. But the combination became a focus of controversy after a study this year showed it was no better at reducing the buildup of plaque in the arteries than simvastatin, the much cheaper generic form of Zocor.
Separately Thursday, leaders of the House Energy and Commerce Committee asked the companies for extensive data on the clinical trial that indicated a possible cancer risk for Vytorin.
Merck and Schering-Plough said they would cooperate with the panel. The companies defend the drug, saying it is effective at reducing cholesterol, its approved use.
Committee Chairman Rep. John Dingell and Rep. Bart Stupak, both Michigan Democrats, sent a letter to the chief executives of the drug companies, giving them two weeks to supply detailed information. The study showing a link to cancer was originally designed to determine whether Vytorin could help prevent a worsening of heart-valve disease, but found that it did not.
The FDA officials anticipate the agency's investigation and analysis will take about nine months.
However, Food and Drug Administration (FDA) officials said patients should not stop taking Vytorin, because the evidence of a cancer link is unclear. While one recent clinical trial indicated higher rates of cancer for patients taking the medication, two current studies have shown no increased risk, agency officials said.
Meanwhile, senior lawmakers in Congress demanded data on the clinical trial that indicated a cancer risk.
Vytorin, a combination of Merck's Zocor and Schering-Plough's Zetia, has been heavily promoted as a novel way to reduce cholesterol. Zocor, a statin, reduces the amount of cholesterol produced by the liver. Zetia limits the cholesterol absorbed through the digestive system. But the combination became a focus of controversy after a study this year showed it was no better at reducing the buildup of plaque in the arteries than simvastatin, the much cheaper generic form of Zocor.
Separately Thursday, leaders of the House Energy and Commerce Committee asked the companies for extensive data on the clinical trial that indicated a possible cancer risk for Vytorin.
Merck and Schering-Plough said they would cooperate with the panel. The companies defend the drug, saying it is effective at reducing cholesterol, its approved use.
Committee Chairman Rep. John Dingell and Rep. Bart Stupak, both Michigan Democrats, sent a letter to the chief executives of the drug companies, giving them two weeks to supply detailed information. The study showing a link to cancer was originally designed to determine whether Vytorin could help prevent a worsening of heart-valve disease, but found that it did not.
The FDA officials anticipate the agency's investigation and analysis will take about nine months.
Monday, August 25, 2008
Critics question cervical cancer vaccine
In two years, cervical cancer has gone from obscure killer confined mostly to poor nations to the West's disease of the moment.
Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.
One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the U.S. government of more than $1 billion. Even the normally stingy British National Health Service will start giving the other vaccine — Cervarix, from GlaxoSmithKline — to all 12-year-old girls at school in September.
The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing.
The vaccines, which offer some protection against infection from sexually transmitted viruses, are more expensive than earlier vaccines against other diseases. Gardasil's list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits, and is often only partially covered by health insurance.
"One less statistic"
Advertising has promoted the vaccines. In ads on shows such as "Law & Order," a multiethnic cast urges girls to become "one less statistic" by getting vaccinated.
The vaccine makers also brought attention to cervical cancer by providing money for activities by patients and women's groups, doctors and medical experts, lobbyists and political organizations interested in the disease.
Even critics of the marketing recognize the benefits of the vaccines. Girls who get the shots are less likely to have Pap tests with worrisome results that would lead to further treatment, saving themselves anxiety and discomfort and, in those cases, saving money. When it occurs, cervical cancer is a dreadful disease; genital warts, partly prevented by the Merck vaccine, can be a painful nuisance.
But some experts worry about the consequences of the rapid rollout of the new vaccines without more medical evidence about how best to deploy them.
In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer.
"There was incredible pressure from industry and politics," said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention (CDC) that recommended the vaccine for all girls once they reached 11 or 12.
"This big push is making people crazy, thinking they're bad moms if they don't get their kids vaccinated," said Dr. Abby Lippman, a professor at McGill University in Montreal and policy director of the Canadian Women's Health Network. Canada will spend $300 million on a cervical-cancer-vaccine program.
Merck's vaccine was studied in clinical trials for five years, and Glaxo's for nearly 6 1/2, so it is not clear how long the protection will last. Some data from the clinical trials indicate immune molecules may wane after three to five years. If a 12-year-old is vaccinated, will she be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary?
Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods.
And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive to use, cervical cancer is classified as rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment.
Because the vaccines prevent only 70 percent of cervical cancers, Pap-smear screening must continue.
"Merck lobbied every opinion leader, women's group, medical society, politicians, and went directly to the people; it created a sense of panic that says you have to have this vaccine now," said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School. Harper was a principal investigator on the clinical trials of Gardasil and Cervarix, and she spent 2006-7 on sabbatical at the World Health Organization developing plans for cervical-cancer-vaccine programs around the world.
"Because Merck was so aggressive, it went too fast," Harper said. "I would have liked to see it go much slower."
In receiving expedited consideration from the Food and Drug Administration (FDA), Gardasil took six months from application to approval and was recommended by the CDC weeks later for universal use among girls. Most vaccines take three years to get that sort of endorsement, Harper said, and then five to 10 more for universal acceptance.
Dr. Richard Haupt, medical director at Merck, said five years in clinical trails was normal before applying for licensing. He said Merck educated people about the new vaccine to "accelerate and facilitate access."
Spokesmen for Merck and Glaxo said all indications are that their vaccines are safe and effective, and there is no evidence a booster shot will be needed.
Need greater elsewhere?
Health economists estimated that depending on how they are used, the two cervical-cancer vaccines will cost society $30,000 to $70,000, or higher, for each year of life they save in developed countries.
Looked at another way, countries that pay for the vaccines will have less money for other health needs. "This kind of money could be better used to solve so many other problems in women's health," said Lippman at McGill. "I'm not against vaccines, but in Canada and the U.S., women are not dying in the streets of cervical cancer."
By contrast, if the vaccine were to become cheap enough to be used in the developing world, it would revolutionize women's health. Charities such as the Global Alliance for Vaccine and Immunizations, backed by the Bill & Melinda Gates Foundation, are trying to devise a solution.
The vaccines offer partial protection against infection from human papillomavirus, or HPV. The Merck vaccine also prevents some genital warts that are caused by other strains of the virus.
Cervical cancer is the second-leading cause of cancer death in women, with 500,000 new cases worldwide each year. More than 90 percent are in developing countries, according to the World Health Organization; 274,000 women died of this cancer in 2006.
Tens of millions of girls and young women have been vaccinated against the disease in the United States and Europe in the two years since two vaccines were given government approval in many countries and, often, recommended for universal use among females ages 11 to 26.
One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country, up to age 18, at a potential cost to the U.S. government of more than $1 billion. Even the normally stingy British National Health Service will start giving the other vaccine — Cervarix, from GlaxoSmithKline — to all 12-year-old girls at school in September.
The lightning-fast transition from newly minted vaccine to must-have injection in the United States and Europe represents a triumph of what the manufacturers call education and their critics call marketing.
The vaccines, which offer some protection against infection from sexually transmitted viruses, are more expensive than earlier vaccines against other diseases. Gardasil's list price is $360 for the three-dose series, and the total cost is typically $400 to nearly $1,000 with markup and office visits, and is often only partially covered by health insurance.
"One less statistic"
Advertising has promoted the vaccines. In ads on shows such as "Law & Order," a multiethnic cast urges girls to become "one less statistic" by getting vaccinated.
The vaccine makers also brought attention to cervical cancer by providing money for activities by patients and women's groups, doctors and medical experts, lobbyists and political organizations interested in the disease.
Even critics of the marketing recognize the benefits of the vaccines. Girls who get the shots are less likely to have Pap tests with worrisome results that would lead to further treatment, saving themselves anxiety and discomfort and, in those cases, saving money. When it occurs, cervical cancer is a dreadful disease; genital warts, partly prevented by the Merck vaccine, can be a painful nuisance.
But some experts worry about the consequences of the rapid rollout of the new vaccines without more medical evidence about how best to deploy them.
In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil — $4,500 for a lecture — and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against a global killer.
"There was incredible pressure from industry and politics," said Dr. Jon Abramson, a professor of pediatrics at Wake Forest University who was chairman of the committee of the Centers for Disease Control and Prevention (CDC) that recommended the vaccine for all girls once they reached 11 or 12.
"This big push is making people crazy, thinking they're bad moms if they don't get their kids vaccinated," said Dr. Abby Lippman, a professor at McGill University in Montreal and policy director of the Canadian Women's Health Network. Canada will spend $300 million on a cervical-cancer-vaccine program.
Merck's vaccine was studied in clinical trials for five years, and Glaxo's for nearly 6 1/2, so it is not clear how long the protection will last. Some data from the clinical trials indicate immune molecules may wane after three to five years. If a 12-year-old is vaccinated, will she be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary?
Some experts are concerned about possible side effects that become apparent only after a vaccine has been more widely tested over longer periods.
And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive to use, cervical cancer is classified as rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment.
Because the vaccines prevent only 70 percent of cervical cancers, Pap-smear screening must continue.
"Merck lobbied every opinion leader, women's group, medical society, politicians, and went directly to the people; it created a sense of panic that says you have to have this vaccine now," said Dr. Diane Harper, a professor of medicine at Dartmouth Medical School. Harper was a principal investigator on the clinical trials of Gardasil and Cervarix, and she spent 2006-7 on sabbatical at the World Health Organization developing plans for cervical-cancer-vaccine programs around the world.
"Because Merck was so aggressive, it went too fast," Harper said. "I would have liked to see it go much slower."
In receiving expedited consideration from the Food and Drug Administration (FDA), Gardasil took six months from application to approval and was recommended by the CDC weeks later for universal use among girls. Most vaccines take three years to get that sort of endorsement, Harper said, and then five to 10 more for universal acceptance.
Dr. Richard Haupt, medical director at Merck, said five years in clinical trails was normal before applying for licensing. He said Merck educated people about the new vaccine to "accelerate and facilitate access."
Spokesmen for Merck and Glaxo said all indications are that their vaccines are safe and effective, and there is no evidence a booster shot will be needed.
Need greater elsewhere?
Health economists estimated that depending on how they are used, the two cervical-cancer vaccines will cost society $30,000 to $70,000, or higher, for each year of life they save in developed countries.
Looked at another way, countries that pay for the vaccines will have less money for other health needs. "This kind of money could be better used to solve so many other problems in women's health," said Lippman at McGill. "I'm not against vaccines, but in Canada and the U.S., women are not dying in the streets of cervical cancer."
By contrast, if the vaccine were to become cheap enough to be used in the developing world, it would revolutionize women's health. Charities such as the Global Alliance for Vaccine and Immunizations, backed by the Bill & Melinda Gates Foundation, are trying to devise a solution.
The vaccines offer partial protection against infection from human papillomavirus, or HPV. The Merck vaccine also prevents some genital warts that are caused by other strains of the virus.
Cervical cancer is the second-leading cause of cancer death in women, with 500,000 new cases worldwide each year. More than 90 percent are in developing countries, according to the World Health Organization; 274,000 women died of this cancer in 2006.
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