A heart attack in progress is a medical emergency. The leading way to stop it is with artery-opening angioplasty. But many angioplasties are done for reasons other than heart attack. Some are performed to ease chest pain that appears with physical activity or stress. This is the chest pain known as stable angina. Sometimes the prospective patient has no symptoms at all — just test results that indicate one or more clogged arteries. Cardiologists continuously debate when it’s appropriate to do non-emergency angioplasty. Two studies in JAMA Internal Medicine add some provocative new information: that incomplete or even misleading advice from doctors contributes to unnecessary angioplasties. And that’s a problem because angioplasty can harm as well as help.
Posts by Daniel Pendick
Marathoners are the thoroughbreds of high-performance runners, but even the draft horses of the running world — slow and steady joggers — improve their health. A study out this week in the Journal of the American College of Cardiology finds that even five to 10 minutes a day of low-intensity running is enough to extend life by several years, compared with not running at all. It shows that the minimal healthy “dose” of exercise is smaller than many people might assume. But if your favorite activity is a brisk walk in the park or a quick game of tennis, the research has implications for you, too. If you don’t currently exercise and make the decision to start — whether it’s walking, jogging, cycling, or an elliptical machine — you are going to improve your health.
With all the warnings against soaking up too much sun, getting ready to go outside can feel like you need a checklist like astronauts use when suiting up for a 6-hour spacewalk in the full blast of the sun’s radiation. Putting on sunscreen and following other sun-smart strategies is for a good cause: preventing melanoma—the most dangerous kind of skin cancer. Curiously, doctors tend not to talk about sunscreen use with their patients. One study showed that, in 18 billion outpatient visits, primary care doctors mentioned sunscreen to just 0.07% of their patients, or roughly 1 in 1,400. But even though your doctor may not mention it, you know better: Put on a broad spectrum sunscreen with an SPF of at least 30 before you go out. Reapply every two to three hours, or more if you are in the water or sweating. Wear a wide-brimmed hat or sun-protective clothing.
A study published in JAMA Internal Medicine this week found that men who used the erection-enhancing drug sildenafil (Viagra) were 84% more likely to develop melanoma, the most dangerous form of skin cancer, over a period of 10 years. That finding makes for an attention-grabbing headline. But it doesn’t tell the real story—that the study found an association (not cause and effect), that this hasn’t been seen in other studies of men, and that, even if it holds true, the absolute increase is small, from 4.3 cases of melanoma for every 1,000 men who didn’t take Viagra to 8.6 of every 1,000 men who took it. The take-home message is that it’s important to worry about melanoma—which is largely caused by getting too much sun—but not yet about Viagra and melanoma.
For women with osteoporosis who are embarking on a “holiday” from taking a bone-building drug, the message from a study released today is “Bon voyage—see you in two years or so.” After menopause, loss of bone (osteoporosis) can lead to crippling fractures of the hip and spine. Drugs called bisphosphonates—alendronate (Fosamax) was the first on the market in the mid-1990s—slow bone loss. But after taking these drugs for a number of years, the balance can begin to tip from help to harm. A new report from the Fracture Intervention Trial Long-term Extension (FLEX) shows that measuring bone density after one year added no information that would have helped doctors identify who was at risk and perhaps should start taking a bisphosphonate again. Waiting two years is a good option for most women.
If you are a baby boomer, the U.S. Centers for Disease Control and Prevention (CDC) recommends that you be tested for infection with the hepatitis C virus. The virus can live in the liver for decades, often causing silent damage that leads to liver failure or liver cancer. But wide-scale testing has proved to be a hard sell. One reason is that treatments to eliminate HCV infection have required weekly injections of one drug and oral doses of others. Treatment could take up to a year. Typical side effects of the injected drug required to clear the virus, called peginterferon, include depression, anxiety, irritability, anemia, and fatigue. Two drug studies published today in The New England Journal of Medicine mark the latest advance in making treatment for HCV easier and more effective. Researchers report that combining several oral antivirals—drugs taken in pill form, not as injections—clear the virus from the liver in more than 95% of people in just 12 weeks. One big obstacle is cost—oral therapy tops $80,000.
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.
Even after intensive rehabilitation therapy, many people who break a hip still can’t do things they used to do with ease, like dressing, rising from a chair, or climbing stairs, after . A report in this week’s Journal of the American Medical Association shows that simple exercises done at home can make a big difference in recovering from a broken hip. A set of “functional exercises” that mimic the kinds of things people normally do in their daily lives improved function and mobility among people who had broken a hip. It’s important :just do it.” At-home rehab is of no use if you don’t stick with it. These kinds of exercises can also help ward off post-fracture complications like blood clots, pneumonia, wound infections, and more. Extended bed rest after a major injury or surgery can feed a downward spiral of physical deconditioning and additional health problems.
A landmark clinical trial done in Spain, known by the acronym PREDIMED, continues to support the health benefits of following a Mediterranean-style eating pattern. Last year, PREDIMED researchers reported that Mediterranean-style eating—rich in fruits, vegetables, and healthy plant oils—prevents heart attacks, strokes, and death from heart disease. This week in The Journal of the American Medical Association, they report that a healthy Mediterranean-style diet can also help prevent peripheral artery disease (PAD), a form of “hardening of the arteries.” It’s an important finding, since as many as 12 million Americans have PAD. It can cause leg pain when walking that goes away with rest (called intermittent claudication); a weakening of the aorta, the main pipeline that delivers blood to the body; pain after eating; erectile dysfunction; and other problems.
Sleep apnea—pauses in breathing while sleeping followed by snoring-like gasps for breath—can cause daytime drowsiness and mental fatigue. It can also boost blood pressure and the risk for developing heart disease. A new study suggests that treating sleep apnea by using a breathing machine during sleep can make a difference for people with hard-to-treat high blood pressure. Although blood pressure medications offer a bigger bang for the buck to reduce blood pressure, treating sleep apnea can help, and offers other benefits as well. Getting used to using a breathing machine, which delivers continuous positive airway pressure (CPAP), may take some work. One key is to find a mask that works, which may be a trial-and-error process.