May 2002

• Fish for Good Health
• On-Pump and Off-Pump Coronary Bypass Surgeries Have Similar Cognitive Outcomes
• Asthma Education Leads to Improvement in Children

Fish for Good Health

In April, three studies delivered powerful evidence that fish is good for you — and could even save your life. The key is omega-3 (or n-3) fatty acids, beneficial polyunsaturated fats provided by many kinds of fish and certain plant foods.

Researchers in the Nurses' Health Study examined 16 years of data involving almost 85,000 women and found an association between fish intake and a lower risk for heart disease and death. Women who ate fish just once a week had a heart attack risk 29% lower than those who ate it less than once a month. Women who ate fish five times a week had nearly half the risk of death from a heart attack.

The Harvard's Physicians' Health Study, which involves more than 22,000 male doctors who initially had no heart disease, analyzed blood levels of omega-3 fatty acids and risk for sudden cardiac death. Researchers found that such deaths were 81% less likely in men with the highest levels of omega-3s. Over half of such deaths occur in people without prior symptoms of heart disease — a compelling reason for adding more fish to your diet.

Finally, Italian researchers reported that heart attack survivors who took fish-oil supplements had a lower risk of sudden death. This trial studied omega-3 fatty acids and vitamin E in 11,000 men and women who had recently suffered heart attacks. Researchers found that 1 gram of omega-3 fatty acids daily reduced the risk for sudden coronary death by up to 42%. This benefit apparently reflects their calming effect on arrhythmias, potentially fatal heartbeat irregularities. Omega-3 fatty acids may also inhibit clotting and improve blood vessel function. The American Heart Association recommends four servings of fish per week but doesn't endorse supplements because of too few data on the subject.

May 2002 Update

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On-Pump and Off-Pump Coronary Bypass Surgeries Have Similar Cognitive Outcomes

Coronary artery bypass graft (CABG) surgery is performed to bypass blood around clogged arteries and improve the flow of blood and oxygen to the heart. But while these surgeries help the heart, they may be harming the brain. A study published in 2000 suggested that 23% of patients suffer from cognitive decline two months after CABG surgery.

The cardiopulmonary bypass, or "on-pump" procedure, has often been blamed for this decline, in part because it generates tiny clots that may affect cognitive function. Recent advances have allowed for CABG surgery to be performed on a beating heart ("off-pump" CABG). A study in the Journal of the American Medical Association examined whether off-pump CABG surgery results in a lower incidence of cognitive decline than on-pump CABG surgery.

Researchers from the Octopus Study Group (named for an off-pump procedure called the Octopus method) randomly assigned 281 patients scheduled for their first CABG surgery to either an on-pump or off-pump procedure. They then administered neuropsychological tests to the patients one day before surgery and then 3 and 12 months after surgery. The tests assessed major areas of cognitive function including verbal memory; visuospatial and motor capacity; selective, sustained, and divided attention; working memory; and information processing. Cognitive decline was defined as a 20% decrease in performance from the baseline score in at least 3 of the areas tested.

At three months after surgery, cognitive decline was found to be 35% more likely after on-pump surgery; it occurred in 29.2% of patients who had the on-pump surgery, compared to 21.1% of patients who had the off-pump procedure. At twelve months, however, the differences in cognitive decline between the two groups were no longer statistically significant — 33.6% of patients who had on-pump surgery compared to 30.8% of patients who had off-pump surgery.

The difference in cognitive decline of off-pump versus on-pump surgery was smaller than expected, and the researchers speculated that factors other than the cardiopulmonary bypass might be responsible for the cognitive decline. They proposed that general surgical trauma may be to blame, or that the off-pump technique itself may be a new source of cognitive decline. They also noted that the mean age of patients in this study (61 years) was younger than the average age (66 years) of patients who have had CABG surgery in the past decade. The off-pump technique may have additional benefits for older patients with more advanced coronary artery disease and who often suffer from additional, unrelated medical conditions.

May 2001 Update

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Asthma Education Leads to Improvement in Children

Managing your child's asthma should include meeting with an asthma educator a few times, according to a follow-up study. Presented at the meeting of the American Academy of Allergy, Asthma, and Immunology, the study reports that after attending an interactive training program three times patients felt less worried about their asthma and had fewer asthma-induced awakenings during the night. Both patients and their caregivers, who also took part in the program, made better decisions about asthma care.

The 30 subjects, asthmatic children ages 6–12, underwent ACE IT! (Asthma Care Education: Intensive Training), an interactive, small-group education program. The sessions included a motivational talk by a teenage athlete with asthma and a pharmacist's discussion of medications. A nurse and asthma specialist also taught the participants about the clinical nature of asthma, environmental controls, relaxation techniques, and asthma action plans.

Researchers evaluated the children at the beginning and end of the training, after six months, and again a year later. After the courses, the number of patients reporting two or more nocturnal awakenings per month dropped from 9 to 5, and the number of symptom-free days also improved, from an average of 20 days per month to over 25 days per month.
The patients were more willing to use the tools available to them, such as medications and peak flow meters, devises that asthmatics breath into to help detect airway changes. They also worked harder to avoid things that triggered their asthma, such as pets or dust.

The researchers plan to continue tracking these 30 children to study the long-term effects on quality of life, morbidity, and cost of treatment. A previous study published in the Journal of Allergy and Clinical Immunology in 2000, found that the training program was much more effective than simply handing out educational materials.

May 2002 Update

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