Women may need different heart treatment
Mon, 03 Sep 2007 16:33:25 GMTBy MARIA CHENG, AP Medical Writer
VIENNA, Austria - Women with heart problems may need to be treated differently than men, doctors said Monday.
Research presented at the annual European Society of Cardiology meeting in Vienna suggested that surgeries which typically save men's lives can be deadly for women.
A small study of 184 women conducted by Dr. Eva Swahn of the department of cardiology at University Hospital in Linkoping, Sweden, found that women who had major heart operations like a coronary bypass were more likely than men to die.
The study was part of a larger study funded by pharmaceutical companies Sanofi-Aventis and GlaxoSmithKline Plc. Swahn consults occasionally for various pharmaceuticals and is writing a book for AstraZeneca.
Although experts said no definitive conclusions can be drawn from Swahn's study, they agreed the idea that women might need different treatment than men should be studied further.
"We have had hints in the past that women don't respond to treatment in exactly the same way as men," said Dr. Christopher Cannon, an associate professor of medicine at Harvard University and spokesman for the American College of Cardiology. Cannon was not connected to Swahn's research.
Last month, the American College of Cardiology revised its treatment guidelines to recommend that doctors should think twice before subjecting women at low risk of heart disease to invasive procedures.
For example, when doctors see women who could have a clogged coronary artery, instead of performing an immediate angioplasty — a procedure in which a tiny balloon inflates the clogged vessel — they should wait and see if further symptoms develop first.
In Europe, the guidelines for treating heart disease are not generally different for men and women.
Women typically have a better chance of surviving a heart attack than men. But in Swahn's study, as in two previous Scandinavian trials that looked at hundreds of women, experts found that women had a higher death rate than men when invasive heart procedures were performed.
In Swahn's study, the women were divided into two equal groups: one which had an invasive procedure like a coronary bypass surgery or an angioplasty and another that waited until further symptoms developed.
Of the women who had an invasive procedure, eight died after one year. That compares to just one death in the other group.
"There is a big question mark over why this is happening," Swahn said. "We want there to be equality between the genders, but that doesn't mean that women and men should get the same treatment."
Doctors are not sure what accounts for the discrepancy. But women tend to have smaller hearts and vessels, which could complicate any surgical procedure. For example, when catheters need to be inserted into the artery to take photos of what is happening inside the body, having smaller arteries does not help.
"Catheters only come in certain sizes," Cannon side. "If the doctor misses, there could be some bleeding."
Women also tend to have more side effects from medicines. Hormonal factors could also play a role, though doctors are not exactly sure how female-specific hormones affect the cardiovascular system.
Compounding the problem is the fact that women are usually about a decade older than men by the time they develop heart problems, so other health problems associated with old age could also worsen their chances of surviving heart surgery.
Tour de France cyclists have big hearts
Mon, 03 Sep 2007 16:56:43 GMTBy MARIA CHENG, AP Medical Writer
VIENNA, Austria - Riding the grueling Tour de France bike race takes strength, stamina — and perhaps a heart nearly 40 percent bigger than normal.
Researchers who examined the hearts of former Tour bikers found that the athletes' hearts were from 20 to 40 percent larger than average, said Dr. Francois Carre of the Centre Hospitalier Universitaire de Rennes, France, speaking at a meeting of the European Society of Cardiology.
The difference is attributable largely to rigorous training that expands the cyclists' hearts. But researchers have not yet determined whether the athletes' hearts were larger to begin with.
"They are a special breed," said Dr. Richard Becker, a professor of medicine at Duke University and spokesman for the American Heart Association. Becker was not connected to Carre's study.
Scientists have long noticed the phenomenon of the "athlete's heart." Athletes who train hard in aerobic sports, such as cycling, running or swimming, tend to have a bigger heart that pumps more blood throughout the body.
The heart's walls become thicker to be able to handle the increased blood volume. That gives the athletes an edge by increasing their oxygen levels and improving their endurance.
Carre's study, funded by the Brittany provincial government in France, is perhaps the first to track what happens to athletes' hearts when they stop training.
Medical tests done on all Tour de France cyclists before the race begins showed virtually all have enlarged hearts, Carre said.
"When you see an athlete's heart test, you know right away that it's not a normal person," he said.
In his study, Carre tracked seven former professional cyclists through their final year of competition and three years of retirement.
Once a year, the cyclists took tests to check the size and function of the heart. They were also tested on their fitness levels.
Carre found that the athletes' hearts shrank nearly a quarter in size after they finished riding professionally. Still, the cyclists remained in excellent physical condition.
"Some athletes have a genetic predisposition to perform better," Carre said. "But we found that in these cyclists, their hearts adapted to the hard training conditions by just getting bigger."
The intense training that Tour de France athletes undergo to race in a three-week-long competition cycling up and down mountains is arguably among the toughest in professional sports.
"When you examine Tour de France athletes, they are probably among the best-trained athletes in the world," said Dr. Alfred Bove, a physician for the Philadelphia 76ers basketball team and vice president of the American College of Cardiology. "This study shows us that even in extreme conditions, the body finds a way to adapt."
Bove said that in athletes with bigger hearts, doping could prove potentially more dangerous than for normal people.
Athletes with bigger hearts have more red blood cells, which deliver oxygen around the body. These cells are thicker than normal cells. So if athletes decide to use an illegal agent like the blood-booster EPO, they run the risk of making their blood too thick. That puts them in danger of a clot, stroke, or heart attack.
"These athletes already have hearts that have increased in volume to adapt to their training workload," Bove said. "If they then go and use drugs, that could potentially erase the natural advantage they already have."
Scientists test new bipolar remedies
Mon, 03 Sep 2007 07:53:19 GMTBy MALCOLM RITTER, AP Science Writer
NEW YORK - Scientists are casting a wide net to find better treatments for the crushing depression and uncontrolled manias of bipolar disorder, and some approaches they're testing seem pretty surprising.
Like skin patches that prevent seasickness. Or a drug that fights Lou Gehrig's disease. And then there's a newly invented device that resembles a hair dryer in a beauty salon.
Some of the strategies were identified by logic, and others by pure chance. Scientists already have evidence that they may someday prove useful against bipolar disorder, also called manic-depression.
Doctors yearn for better therapies to treat the condition, which can rip careers and marriages apart and drive people to suicide. It is so complex and mysterious that researchers haven't developed a medication specifically for it since lithium, more than half a century ago.
Bipolar disorder appears in various forms and degrees of severity in about one in every 25 American adults at some point in their lives, according to a major study published in May.
The disorder is characterized in part by episodes of mania, which are periods of boosted energy and restlessness that can run for a week or more.
"You have so much energy, you have so many great ideas" said Tamara, 26, a Pittsburgh resident who was diagnosed several years ago. She asked that her last name not be used.
"You feel like you're thinking so clear, you've got the answer for everybody. You need to tell them, you need to phone all your friends... It's so hard to sleep. You keep thinking of all sorts of things."
But mania can also bring extreme irritability. Tamara's energy and charisma made her the life of the party, but "if somebody spilled a drink on me, I would just explode," she recalled. "It's like all your emotions are just completely intensified."
She got into fights and experienced road rage. She made bad decisions, plagiarizing a college paper and behaving promiscuously.
"A lot of things sound like a good idea when you're manic," she said, "and they're really not."
During manic episodes many people even get hallucinations or delusions, and Tamara experienced those too. "I was convinced I could hear other people's thoughts, or at least know what they were," she recalled. "I thought everybody was saying bad things about me."
The disorder also brings episodes of depression that last a week or more.
"Nothing is interesting," Tamara said. "You're bored with everything... Nothing sounds fun anymore. All you want to do is sleep. I slept days and days away."
In her senior year of college, thoughts of suicide frightened her into seeking help.
Doctors currently treat bipolar with a variety of drugs including lithium, anticonvulsant medications that can stabilize mood, and antipsychotics. Psychological therapy and patient education greatly boost the effectiveness of the drugs.
Tamara takes lithium and another drug, and says, "I'm doing fine right now."
She's lucky. Bipolar disorder is hard to treat chiefly because the depressive episodes are more severe and more resistant to therapy than ordinary "unipolar" depression, notes Dr. Andrea Fagiolini, an associate professor of psychiatry at the University of Pittsburgh.
Overall, current medications for bipolar "certainly reduce symptoms but don't do a good enough job," said Dr. Husseini Manji of the National Institute of Mental Health. "Many patients are helped, but they're not well."
What's more, many patients can't tolerate current bipolar medications because of side effects like weight gain, sleepiness, tremor, and the sense of feeling "drugged," Fagiolini said. .
A study of treated patients published last year found that about 60 percent got well for at least eight weeks, but only half of that group remained well when followed for up to two years. That was with very good therapy, noted Dr. Andrew Nierenberg, professor of psychiatry at Harvard Medical School.
"That means there's a lot of room for improvement," Nierenberg said. "That's why we need new treatments."
Just as heart attacks come from chronic heart disease, the manic and depressive episodes come from an underlying chronic brain disease. And "we just don't really understand what's behind the illness," said Dr. Gary Sachs, who directs bipolar research at Harvard's Massachusetts General Hospital.
The mystery and complexity of the disorder have discouraged scientists from trying to develop drugs for it, Manji said. Not since lithium have they developed a drug specifically for bipolar, Manji said.
Like lithium, some of the latest crop of early candidate drugs revealed their potential simply by chance.
Take the experience of NIMH researchers Maura Furey and Dr. Wayne Drevets with the drug scopolamine, which is normally used to keep people from getting seasick or carsick. Several years ago, they were studying whether scopolamine could improve memory and attention in depressed people. So they gave the drug intravenously to depressed patients, trying to find the right dose for a brain-imaging study.
They noticed that patients started feeling less depressed the night after the injections. Most antidepressants take weeks to kick in.
"Some patients would say it was the best night of sleep they'd had in many years, and the next morning they woke up feeling a substantial lifting of their depression," Drevets said. "In many cases that improvement persisted for weeks or even months."
Drevets and Furey quickly changed their research focus to test the drug's effect on depression itself. And in October 2006 they published an encouraging, though preliminary, result with a small group of depressed patients, some of whom were bipolar.
Now Furey is leading a study using scopolamine skin patches — like travelers wear to prevent motion sickness — to treat depression in bipolar disorder as well as ordinary depression. For now, people shouldn't try patch treatment for depression on their own, she said.
A similar bit of serendipity showed up at McLean Hospital in Belmont, Mass., in 2001. Depressed bipolar patients who were getting their brains scanned for a study of brain chemistry suddenly felt a lot better. Alerted by a research assistant, scientists started taking a closer look. And in 2004, they published their conclusion that the electric fields produced by the brain scans might lift depression. It's still not clear how.
Follow-up studies have had inconsistent results. But researchers have now built a device that resembles a hair-salon dryer to produce electric fields. They plan to start testing it this fall.
Researchers have also used the few insights they have into the disease to develop potential treatments.
That's the story with riluzole, now used to treat the paralyzing disorder Lou Gehrig's disease, also known as ALS or amyotrophic lateral sclerosis. Scientists found that a drug that's effective against depression in bipolar disorder boosts the abundance of a certain protein in rat brain cells, and that riluzole does too. So the researchers tried riluzole in a small number of depressed bipolar patients, and in some patients the symptoms virtually disappeared, Manji said.
So riluzole, which is distributed by Sanofi-Aventis, might become a treatment for bipolar disorder, he said.
Similar research used an off-the-shelf drug to get a lead for developing a new medication. Studies in rats showed that lithium and another anti-mania drug hamper the effect of a particular enzyme in the brain. That suggested other drugs that hamper the enzyme might work against mania too, Manji said.
The best available candidate: tamoxifen, used to fight breast cancer. Manji's recent study in a small group of bipolar patients found that tamoxifen quickly quelled mania. Other studies have found similar results, he said.
That shows the value of blocking the enzyme, and now Manji is trying to develop other drugs that will do that, perhaps for use in emergency rooms. He wants to avoid tamoxifen itself because of concern about long-term side effects, since his work requires a higher dose than women use to stave off breast cancer for years.
Scientists say the real key to unlocking the mysteries of bipolar disorder — and thereby exposing targets for drugs — lies in a new generation of research into DNA.
In recent months, scientific journals have begun to publish the early results of a revolution in DNA analysis: the ability to scan entire genomes in detail to find genetic variants that predispose people to particular diseases. Some of the new work is implicating dozens of variants in bipolar disorder.
Such work can expose the hidden biological underpinnings of disease, and tip off researchers to unsuspected targets for intervening.
"We've been stumbling in the dark for most of our history" of bipolar research, said gene expert Dr. Francis McMahon of NIMH. But "these kinds of studies ... will really give us the chance to reason from biological insights back to the patient."
Sachs, of Harvard, agreed: "I think these whole-genome scans will in fact be the important bridge to better treatments."
And not just in some far-distant future. The new gene studies, Sachs said, help give "a great potential to advance the field in our lifetimes and treat people who are living now."
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On the Net:
Bipolar information: http://www.nimh.nih.gov/healthinformation/bipolarmenu.cfm
National Alliance on Mental Illness: http://www.nami.org
Depression and Bipolar Support Alliance: http://www.ndmda.org
Disease treatment studies: http://www.clinicaltrials.gov
Study Arrhythmia riskier in athletes
Mon, 03 Sep 2007 01:43:30 GMTBy MARIA CHENG, AP Medical Writer
VIENNA, Austria - Cardiac problems like an abnormal heartbeat are exacerbated by rigorous exercise in a way that can be fatal in athletes, and regular testing for the problem could save lives, doctors at a heart conference said Sunday.
Italy is the only country that mandates heart screening of all its professional athletes, Dr. Domenico Corrado of the University of Padua said at the European Society for Cardiology meeting in Vienna.
Since 1981, Italian authorities have run heart checks on all competing athletes. The incidence of sudden, fatal heart attacks has dropped from four cases per 100,000 to 0.4 cases per 100,000.
Without testing, athletes genetically predisposed to having an irregular heartbeat might not be aware of their condition until it's too late, doctors said. Adrenaline produced during exercise may overstimulate the heart, causing it to essentially short-circuit.
"Sport acts as a trigger," Corrado said in research presented at the meeting.
Corrado said he had no ties to companies involved in screening athletes. The research was funded by the Italian government.
Last week, Antonio Puerta became the latest high-profile soccer player to die while competing.
After the 22-year-old Sevilla midfielder lost consciousness and fell, doctors treated him on the field and he walked off, but then had a heart attack in the locker room and another in the emergency room of a Seville hospital.
He died three days later.
A day after Puerta's death, former Zambia striker Chaswe Nsofwa died minutes after collapsing on the field during a training session with Israeli club Hapoel Beersheba. The 27-year-old Nsofwa was given electric shocks and an external pacemaker but could not be revived by paramedics.
On Aug. 24, 16-year-old Anton Reid of English League One team Walsall died after collapsing on the field.
Because they have been exercising vigorously, many athletes who collapse during competition do not have enough oxygen in their bodies to allow the heart to start pumping again, even if a defibrillator is used to try to restart their heart.
FIFA, world soccer's governing body, deemed the risk of irregular heartbeats to be so great that before last year's World Cup in Berlin, its medical committee demanded that all players undergo heart scans. Following the recent deaths, FIFA said it was considering expanding health checks.
"Athletes may have a silent but important heart disease that's not ... manifest," said Dr. Douglas Zipes, a cardiologist at Indiana University School of Medicine. Though little data exist, Zipes said that a genetic disorder may cause some athletes' hearts to get abnormally big when they train.
Corrado estimated that the cost of Italy's heart screening program is about $82 per athlete. Other countries are not convinced that screening is worth the cost, given how few athletes are at risk. Concerns have been raised about the effectiveness of the scan, which relies largely on echocardiograms, a test that shows if the heart is pumping normally.
"As a screening test, it's very imperfect," said Dr. Gordon Tomaselli, chief of cardiology at Johns Hopkins University and spokesman for the American Heart Association. "It can pick up many of the things that cause sudden death, but not all of them."
Doctors said that more awareness about the potential dangers is key to preventing future deaths, though not all athletes with suspicious tests will collapse on the field.
"Coaches should pay more attention to their players' symptoms," Zipes said. "If an athlete is complaining about chest pains or shortness of breath, those are warning signs that should not be ignored."
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Associated Press sports writer Chris Lehourites in London contributed to this report.
