Cardiologists from around the world have gathered in Washington, DC, for the 65th annual meeting of the American College of Cardiology in Washington, DC. During the opening lecture, Dr. Gary Gibbons, director of the National Heart, Lung, and Blood Institute, talked about the “challenge of success.” What does that mean? Since 1950, death rates from cardiovascular disease have plummeted by 70%, thanks to two major trends. One is the decline in smoking and improvements in cholesterol and blood pressure. The other is the boom in new therapies, including better medications, surgeries, and high-tech procedures to repair an array of heart problems. The challenge today is finding a new drug or procedure that raises this already high bar. Here’s a summary of four reports, two negative and two positive, of studies on new treatments for heart disease.
Archive for March, 2014
For anyone who has had a stroke, working to prevent a second one should be Job No. 1. Keeping blood pressure under control is an important part of that job. A study published yesterday in the journal Stroke shows that good blood pressure control after a stroke cuts the chances of having a repeat stroke by more than half. But the study also brought some bad news: less than one-third of stroke survivors in the study managed to get their blood pressure under control. Measuring blood pressure at home is one way to help control blood pressure—seeing that it is high can help you take steps to bring it down. These include lifestyle changes and medications.
A new report from the Alzheimer’s Association says that as many as 5 million Americans have Alzheimer’s disease or some other form of dementia. Every 67 seconds someone in the United States develops Alzheimer’s disease or dementia. That’s 470,000 Americans this year alone. Given that these thieves of memory and personality are so common and so feared, should all older Americans be tested for them? In proposed guidelines released yesterday, the U.S. Preventive Services Task Force said “no.” Why not? Even after conducting a thorough review of the evidence, the panel said that there isn’t enough solid evidence to recommend screening, especially since not enough is known about the benefits and the harms. In part, the recommendation is based on the sad fact that so far there aren’t any truly effective approaches to stop the forward progress of dementia.
Some good news on the cancer front: between 2000 and 2010, rates of colorectal cancer in American adults fell by about one-third. That decline mirrored a sharp rise in colorectal cancer testing during the same period. American Cancer Society researchers found that the drop in colorectal cancer rates was highest among Americans aged 65 years and older. Cases fell 3.6% a year from 2001 to 2008, then dropped even more by 7.2% a year from 2008 to 2010. But the researchers saw a troubling trend in younger adults: an increase in colorectal cancer of 1.1% a year among people under age 50. Rising obesity rates may be to blame. The researchers attribute the decline in colorectal cancer to early testing for the disease. Despite the optimistic findings, colorectal cancer is still a scourge. In the U.S. this year, an estimated 72,000 men and 65,000 women will be diagnosed with colorectal cancer; 26,000 men and 24,000 women will die of it.
Severe headaches are a misery, whether they cause a dull ache or a steady, stabbing, or blinding pain. Such pain rarely comes from something catastrophic, like a tumor or a bleeding in the brain. Yet an estimated 12% of people with headaches get brain scans. A new study shows that these unnecessary scans add several billion dollars a year to health care costs for very little benefit. Excessive brain scanning costs more than just dollars. Repeated CT scans deliver enough radiation to increase the odds of developing cancer. Scans also tend to lead to more scanning if the test turns up something strange. Many people who see a doctor because of severe and recurrent migraine headaches don’t need brain scans. They need the right therapy to stop their pain.
How bad can a little high blood pressure be? It turns out that it might be worse than we thought. Researchers from Southern Medical University in Guangzhou, China, examined the results of 19 high-quality studies looking at links between prehypertension and stroke. The studies included more than three-quarters of a million people, whose health and wellbeing was followed for 36 years. Those with “high-range prehypertension” (blood pressure between 130/85 and 139/89) had a 95% higher stroke risk compared to people with healthy blood pressures. Those with “low-range prehypertension” (blood pressure between 120/80 and 129/84) had a 44% higher stroke risk. The size of the study and the length of the followup make the results believable. They don’t mean that we should elevate prehypertension to a disease. But they do signal that we need to take it seriously. The best way to treat prehypertension is with lifestyle changes.
An estimated 43.5 million Americans provide in-home, long-term care for older adult family members with a chronic illness. In a new JAMA survey, caregivers are typically women who spend about 20 to 40 hours a week providing care. Most caregivers feel abandoned and unrecognized by the health care system. Spousal caregivers face greater challenges than caregivers helping a parent for a variety of reasons, one of which is that they tend to be older. Many caregivers don’t know about, or take advantage of, services and support systems such as respite care, help with non-medical services such as housekeeping and cooking, counseling, and more. The Caregiver’s Handbook, a Special Health Report from Harvard Medical School, includes detailed information that can help women and men provide better care for their loved ones and take care of themselves.
The next time you have your blood pressure checked, ask your health care to check it in both arms, rather than just in one. Why? A big difference between the two readings can give you an early warning about increased risk of cardiovascular disease, a new study suggests. Harvard researchers found that people who have a 10-point difference in blood pressure from one arm to the other are 38% more likely to have a heart attack, stroke, or a related problem than those with arm-to arm differences less than 10 points. Small differences in blood pressure readings between the right and left arm are normal. But large ones suggest the presence of artery-clogging plaque in the vessel that supplies blood to the arm with higher blood pressure. Clogging there means there’s a good chance the arteries in the heart and brain are also clogged, boosting the odds of having a heart attack or stroke.