Many medical studies confirm what we know or suspect. Every once in a while, though, one surprises us, turning “conventional wisdom” on its head. That just happened with the sudden shutdown of a long-running diabetes trial called Look AHEAD (Action for Health in Diabetes). Begun in 2001 and scheduled to last another two years, Look AHEAD was designed to see if an intensive diet and weight loss program could reduce the number of heart attacks, strokes, and other cardiovascular problems in people with type 2 diabetes. An early peek at the data showed that the program had little apparent effect, and the investigators concluded it would be futile to continue. This does not mean that we should ignore diet and exercise in treating of type 2 diabetes. Instead, the details of the study results, which haven’t yet been published, are likely to reveal other explanations.
Howard LeWine, M.D.
Posts by Howard LeWine, M.D.
In a car culture like ours, giving up the car keys can be a wrenching decision. Some see it as a loss of independence. For others, especially those who live in areas with poor public transportation, not driving makes it difficult to shop for groceries or see friends. But the fact is that some older people need to make that decision. Pleas from family members can sometimes do the trick. A special article in this week’s New England Journal of Medicine suggests that advice from a doctor can also help people who shouldn’t be behind the wheel any longer stop driving. There are no guidelines regarding who is fit to drive. Sadly, many people finally stop driving after they’ve crashed, or hurt someone. This is definitely a situation where “better safe than sorry” should rule.
For years researchers have been trying to weigh the benefits of finding early breast cancers against the risks related to false positives (the spots that turn out to be harmless). This work has sparked some bitter public debates and confusion for women over flip-flopping recommendations. The latest salvo comes from a review of the results of mammograms among more than 12 million women in 18 European countries. The results support the idea that routine mammograms can prevent deaths from breast cancer without causing undue harm. The findings support the U.S. Preventive Services Task Force’s recommendation that women between the ages of 50 and 74 have a mammogram every other year. Women at higher risk of developing breast cancer may need mammograms earlier than age 50, or more often than every other year.
Most people don’t think twice about taking Motrin, Advil, Aleve, or similar over-the-counter painkillers. A new study suggests that heart attack survivors should use these drugs, known as nonsteroidal anti-inflammatory drugs (NSAIDs), as little as possible. A team of Danish researchers found that among heart attack survivors, those who used an NSAID were about 60% more likely to have died during each year of the five-year study than those who didn’t use an NSAID. Of all the NSAIDs, diclofenac (Cataflam, Voltaren, generic) was linked to the largest increases in death or heart attack rates, while naproxen (Naprosyn, Aleve, generic) appeared to carry the lowest risk. The lower risk with naproxen confirms what has been seen in older studies. If you have heart disease and need pain relief, try acetaminophen first. If you need an NSAID, naproxen is probably the best choice for your heart. But whatever you and your doctor decide is best for you, use the lowest dose possible for the shortest period of time.
What would you pay to keep from getting sick as you get older? How about a daily walk or other exercise? A new study suggests that’s exactly the right investment. In the study, people who were the most fit at midlife lived longer and spent less time being sick than middle-aged folks who weren’t fit. There are many benefits to staying physically active and exercising daily. One important effect of exercise that doesn’t get enough attention is that it improves fitness. Fitness is a measure of how well your heart, blood vessels, blood, and lungs work together to supply muscles with oxygen during sustained exercise. How do you improve your fitness? Increase the amount and the intensity of exercise over time. Don’t rush it. Improving fitness starts within weeks but will continue for months.
The United States is in the midst of the largest outbreak of West Nile virus since that virus was first discovered here in 1999. So far this year, more than 1,100 cases of human West Nile infection have been reported, about half of them in Texas, and at least 40 people have died from the virus. More cases are expected, since West Nile virus infections generally peak in late August and September. The virus is transmitted to humans by mosquitoes. Mosquitoes pick it up by feeding on birds carrying the virus. Very rarely, West Nile virus infection occurs due to transfusion of infected blood. It can’t spread from human to human by casual contact. None of the antiviral drugs currently available kill West Nile virus. And no vaccine is available. Prevention is best: stay inside when mosquitoes are most likely to bite, and use insect repellant when outside.
You’ve probably heard the saying, “It takes a village to raise a child.” After reading about Rosie O’Donnell’s heart attack, I’d like to coin a new one: “It takes a celebrity to sound the alarm about important health issues.” The 50-year-old actress, comedienne, and talk show host suffered a surprise (aren’t they all) heart attack last week. Word got out when she wrote about it on her blog. O’Donnell brushed off some chest pain and arm pain as muscle aches related to some heavy lifting, ditto later feelings of nausea and clammy skin. When she went to the hospital the next day, a key artery in her heart was 99% blocked. At age 50, O’Donnell may have thought she was too young for those problems to signal a heart attack. She also wasn’t familiar with a heart attack’s sometimes sneaky signs and symptoms. O’Donnell urges “know the symptoms ladies/listen to the voice inside/the one we all so easily ignore/CALL 911/save urself.”
A heart attack (more formally known as myocardial infarction) isn’t always an instantly recognizable event. Severe chest pain often has nothing to do with the heart or blood vessels. Some heart attacks are so small they pass almost unnoticed, written off as indigestion or the flu. Others are major catastrophes, causing death or long-lasting disability. A new blood test may help speed the diagnosis. This is important, because the sooner a heart attack is diagnosed, the sooner treatment can begin. The sooner treatment begins, the more heart muscle can be saved. The new test can detect very small amounts of troponin in the blood. This protein is one of the chemical signatures of dying heart cells. This new test could let doctors identify small heart attacks that would otherwise go undiagnosed, or identify heart attacks earlier—and begin treatment earlier.
We tend to think of type 2 diabetes as a disease that afflicts people who are overweight. But it can also appear in people with perfectly healthy weights—and be more deadly in them. A study published in the Journal of the American Medical Association indicates that normal-weight people diagnosed with type 2 diabetes have double the risk of dying from heart disease and other causes than overweight people with diabetes. Such apparent “protection” by excess weight has been called the obesity paradox. It’s been seen with other conditions, like heart failure and end-stage kidney disease. That doesn’t mean gaining weight is a healthy strategy. Instead, it probably means that something else besides weight—like the amount of fat around the waist—may be contributing to the onset and severity of type 2 diabetes. These new findings underscore the importance of strength training for everyone, no matter what their weight.
New guidelines now urge adults who have been infected with HIV to start taking HIV-fighting drugs as soon as possible, ideally within two weeks of being diagnosed with the infection, rather than waiting to see what happens with white blood cell counts. By preventing the virus from multiplying in the body, this strategy can maintain health and slow—or even stop—the progression to AIDS. Equally important, taking anti-HIV drugs early can decrease the odds that a person will spread HIV to someone else as much as 96%. The new guidelines, from the International Antiviral Society—USA Panel, were presented at the 19th International AIDS Conference, now going on in Washington DC. The new guidelines aren’t without their challenges. Patients must be “ready and willing” to stick with drug therapy, which can be complicated. Another hurdle is cost. An effective anti-HIV drug strategy costs more than $1,000 a month.