Most angioplasties unneeded study finds
Tue, 27 Mar 2007 05:25:39 GMTBy MARILYNN MARCHIONE, AP Medical Writer
NEW ORLEANS - More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.
The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.
An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.
"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."
He led the study and gave results Monday at a meeting of the American College of Cardiology. They also were published online by the http://www.nejm.org
Heart meeting: http://www.acc.org
Aspirin shows benefit in older women
Tue, 27 Mar 2007 03:02:48 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - Aspirin in low to moderate doses may lower the risk of death in women, particularly those who are older and prone to heart disease, a 24-year study of nearly 80,000 women suggests.
However, experts cautioned that the results are not definitive and that women should not take aspirin as a health preventive without talking to their doctor.
In this long-running study of nurses who were middle-aged and older, women who took aspirin had a 25 percent lower risk of death compared to those who never took it. Aspirin-takers had a 38 percent lower risk of death from cardiovascular disease and a 12 percent lower risk of death from cancer.
Many doctors advise people who've had heart attacks and strokes to take a daily 81-milligram baby aspirin, costing less than 50 cents a week. The new study suggests aspirin may help healthy women, too.
No benefit was found for high doses, which the study defined as two or more standard 325-milligram aspirin tablets a day.
"This confirms what we already know: Aspirin is good for you, whether you're a man, whether you're a woman," said Dr. Jeffrey Berger of Duke University Medical Center who studies aspirin's effects. He was not involved in the new research and receives no money from aspirin makers.
However, since aspirin can cause ulcers and bleeding, Berger said, women should talk to their doctors before taking it to prevent disease.
"It's not a little vitamin; it's not a sugar pill," he said.
Most of the best-designed studies have not found that aspirin lowers the risk of death. But they have found that aspirin helps to prevent heart attacks in men and strokes in women.
Aspirin is thought to prevent heart attacks and strokes by blocking platelets from forming blood clots. Its anti-inflammatory properties may also play a role in preventing cancer.
The average age of the women was about 46 at the start of the study and about 70 by its end. The women at risk for heart attacks and strokes, and older women, got the most benefit.
The size and length of the new study, appearing in Monday's Archives of Internal Medicine, make the results compelling. But the research, based on data from the long-running Nurses Health Study, was observational, meaning the women chose whether to take aspirin, rather than being randomly assigned to take it — a gold standard in research.
The aspirin-takers could have been healthier than other women for reasons the researchers didn't take into account. The aspirin-takers also could have been more zealous about how they took other medicine, for example.
"We cannot prove a cause-and-effect relationship and the results should be interpreted with caution," said study co-author Dr. JoAnn Manson at Harvard-affiliated Brigham and Women's Hospital. "We don't want people hearing about the study and beginning to take aspirin long-term without having a discussion with their doctor."
The researchers matched 9,477 women who died between 1980 and 2004 with women who didn't die. They looked at which women reported taking aspirin and took into account other risk factors such as high blood pressure, diabetes, smoking and weight.
Cancer was the leading cause of death in the study. The researchers said they'd expect more deaths from heart attacks and strokes if the women in the study had been older. Cardiovascular disease is the leading cause of death in American women.
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Drugs for good cholesterol fail tests
Mon, 26 Mar 2007 22:52:21 GMTBy MARILYNN MARCHIONE, AP Medical Writer
NEW ORLEANS - The hot new strategy of trying to prevent heart disease by raising good cholesterol had more setbacks Monday as new studies showed that experimental drugs didn't work and also had safety problems.
The news follows Pfizer Inc.'s abandonment in December of an $800 million investment in torcetrapib, the leading contender in this class of drugs, because it raised the risk of heart attacks and deaths.
Heart specialists have been anxious to know whether the problems extend to all such drugs and doom this approach.
"A lot of people think it's the next big thing, and we'll need to understand what went wrong with torcetrapib to move forward," said Dr. Steven Nissen, a Cleveland Clinic heart specialist who is president of the American College of Cardiology.
The new studies, reported at the group's conference, gave a mixed answer. The Pfizer drug seems uniquely risky, but other drugs have problems, too.
And even though they and the Pfizer drug raised HDL good cholesterol as intended, that made no difference in the odds of heart attacks or deaths, or key measures of cholesterol buildup in arteries.
Doctors long have focused on lowering LDL, or bad cholesterol, to cut heart attack risk. Statins, sold as Lipitor and Zocor and also in generic form, lower LDL, which ferries fats from food into the bloodstream.
But many statin users suffer heart attacks anyway, so doctors have been trying to boost HDL, or good cholesterol — which transports fat from the blood to the liver to be disposed of — to further lower risk.
An extended-release niacin drug called Niaspan, sold by Kos Pharmaceuticals Inc., does this. But it can cause a prickly hot sensation called flushing that some people find intolerable. Pfizer, Merck & Co. and Swiss drug maker Roche Holding AG are testing drugs that boost HDL in a novel way.
Pfizer shares rose 7 cents to $25.73 in afternoon trading on the New York Stock Exchange while Merck stock sank 42 cents or nearly 1 percent to $44.03 on the NYSE. Meanwhile, Roche's U.S. traded shares were flat at $90.05 on the Pink Sheets.
On Monday, scientists reported the results of several studies on torcetrapib. In one, the drug boosted HDL by 61 percent, but trends in death, hospitalization and heart attacks "are all going in the wrong direction," Nissen said.
An experimental diabetes drug by Eli Lilly and Co. that is 10,000 times more potent than fibrates, a current cholesterol treatment, also proved disappointing. The new drug raised HDL but also raised the risk of kidney, heart and other serious problems, Nissen reported.
Finally, infusions of a reconstituted form of HDL developed by CSL Ltd., an Australian company, made no big difference in the burden of artery buildups in a study led by Dr. Jean-Claude Tardif of the Montreal Heart Institute.
In several of these studies there were hints of some improvements in less important measures of artery buildup, which provides "a glimmer of hope for future development of this class of drugs," Dr. Alan Tall of Columbia University writes in an editorial in the New England Journal of Medicine.
That journal and the Journal of the American Medical Association published several of the new studies.
"The bar has been raised a lot for this entire class, but I do not think we can abandon this entire approach," Nissen said.
If Baycol had been the first statin tested and research had stopped after safety problems emerged, there wouldn't even be this class of drugs, he noted. Baycol, sold by Bayer AG, was withdrawn from the market in 2001 after reports of a severe and sometimes fatal muscle disorder.
Colon checks rising but not enough
Mon, 26 Mar 2007 20:55:30 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Sam Monismith was prepped and ready to begin his colonoscopy when health workers brought the university professor awkward news: His insurance wasn't going to cover the colon cancer check. They wanted a signed promise to pay, or the test was off.
Monismith hesitated only briefly — and the test uncovered nine polyps, precancerous growths in his colon. Even better, because doctors removed them on the spot, the bill switched from a cancer screening that insurance wouldn't pay into a surgical procedure it did.
"The irony of it is if I hadn't had any polyps, I would have had to pay," says Monismith, 54, of Harrisburg, Pa., who has had additional polyps removed in the four years since that first check. "I'm just glad I got the test."
Insurers insist Monismith is a rarity and that most insurance does cover colon cancer screening once people hit age 50, when the risk starts to rise. Still, cancer advocacy groups have begun a push to ensure the last holdouts cover all four government-recommended options — from the $20 annual stool sample to once-a-decade colonoscopies that can exceed $1,000.
Fifteen states are considering legislative mandates, by the http://www.cancer.org/docroot/PED/PED_5.asp
