Study Statin helps prevent heart attack
Wed, 10 Oct 2007 21:01:55 GMTBy LINDA A. JOHNSON, Associated Press Writer
Cholesterol-lowering statin drugs help prevent heart attacks for at least a decade after people stop taking them, the first long-term study of the world's top-selling type of medication finds.
The research follows up on a study in Scotland showing that men taking the drug Pravachol for five years substantially lowered their risk of heart attack and death from heart disease.
They were followed for another 10 years after most stopped taking the drug. That group was compared with a group of men who were given dummy pills during the five-year study. There was a 25 percent lower risk of heart attack or death from heart disease among those in the statin group, when compared with the placebo group.
The study participants were middle-aged men who had never had a heart attack but who had a very high average level of LDL, or bad cholesterol — 192.
While the study found protection lasted after statin use stopped, the drugs usually are prescribed indefinitely, especially for people with known heart disease. Federal guidelines say these drugs are very safe and may be used by people with LDL levels as low as 130, or even 100 if they are at very high risk of heart attack.
The new results, based on medical records from more than 90 percent of the men in the original experiment, appear in Thursday's New England Journal of Medicine.
The researchers wrote that statin's protective effect was probably because existing plaque was stabilized and the progression of coronary artery disease was slowed.
"Continuing treatment after five years may be beneficial," they wrote.
After the original study ended in 1995, participants returned to their own doctor's care and decided whether to continue or start taking statins. Five years later, about 39 percent of the original statin patients were still taking the drugs, and 35 percent of the placebo takers were using statins.
Over the 15-year period, 619 of the original statin takers and 674 of the placebo takers died.
Dr. Michael J. Domanski of the National Heart, Lung, and Blood Institute said the study's biggest weakness is the fact that after the study ended, more of the original statin patients took the drugs than those in the placebo group.
The researchers argued that that difference couldn't explain the overall long-term protection demonstrated in the study.
Domanski wrote in an editorial that the study clearly shows the benefit of statin use "is durable over the long term" and that there now can be no doubt reducing levels of LDL cholesterol has a role in preventing and treating heart disease.
Still uncertain, he added, is how early people with high cholesterol should start using statins and how low one's LDL should be for the most benefit.
Currently, the National Cholesterol Education Program, a federally funded advisory group, and leading heart doctor groups recommend cutting the LDL level to below 70 for patients at very high risk of a heart attack, below 100 for high-risk patients and below 130 for moderate-risk patients.
The follow-up study was partly funded by Bristol-Myers Squibb Co., the maker of Pravachol, and Daiichi Sankyo Inc., maker of the statin WelChol. All but one of the researchers reported receiving consulting fees, lecture fees or research grants from a total of five other pharmaceutical companies, four of which sell statins.
___
On the Net: http://www.nejm.org
National Cholesterol Education Program: http://www.nhlbi.nih.gov/about/ncep/
Study Kids get inadequate health care
Wed, 10 Oct 2007 21:04:35 GMTBy LINDA A. JOHNSON, Associated Press Writer
As Washington debates children's health insurance, a startling study finds that kids who regularly see doctors get the right care less than half the time — whether it's preschool shots or chlamydia tests for teen girls.
The findings, from the first comprehensive look at children's health care quality, are particularly troubling because nearly all the 1,536 children in the nationwide study had insurance.
Eight-two percent were covered by private insurance. Three-quarters were white, and all lived in or near large or midsized cities.
Two experts called the findings "shocking." Others said minority children, those with more-restrictive government insurance, and the millions with no insurance at all certainly fare even worse.
They said the results highlight the importance of the debate over the proposed expansion of the State Children's Health Insurance Program, which Congress approved and President Bush vetoed. A vote to override the veto is set for next week.
The study, by the Seattle Children's Hospital Research Institute and the nonprofit Rand Corp. research group, concludes that overall, doctors gave children the appropriate outpatient medical care only 47 percent of the time.
"They got an 'F'," said Dr. Joseph F. Hagan, a Burlington, Vt., pediatrician. Hagan co-edited the American Academy of Pediatrics' latest update to its children's health guidelines, due out later this month.
"It's sad, but I think it reflects some unpleasant realities about our current health care system or, I might say, non-system," Hagan said.
The compliance rate was even worse than that found in a study of adults: They got only 55 percent of recommended care.
The new research found children's doctors did best in providing the recommended care for acute medical problems — 68 percent. They scored just 53 percent for treating chronic conditions and 41 percent for preventive care.
"I was really taken aback by the results for preventive care," said Dr. Rita Mangione-Smith, lead investigator at the Seattle institute and an associate professor at the University of Washington. "It was really kind of distressing to me that there was some really basic stuff that we should be doing that's just not happening."
The study, based on a review of two years of medical records of children in 12 metropolitan areas, was reported in Thursday's edition of the New England Journal of Medicine.
The data were collected from late 1998-2000. Experts said it's unlikely children's health care has improved since then.
The researchers found a huge variance in the rates at which doctors provided care recommended for the most common illnesses and for promoting health.
Kids got the right care 92 percent of the time for upper respiratory infections and 85 percent of the time for hay fever. But they got it only 48 percent of the time for urinary tract infections, 46 percent for asthma and 35 percent for adolescent preventive care.
For instance, only 15 percent of adolescents seen by a doctor got weighed annually. Yet about one-third of American children are overweight and many are developing high blood pressure and diabetes, setting themselves up for long-term health problems.
"There can be dire consequences for the children, for their families and for society as a whole," including death, when these easily managed conditions are not controlled, said Julia Paradise of the Kaiser Family Foundation.
She noted the proposed expansion of the SCHIP program was to include the first major initiative to measure and find ways to improve quality of care for children covered by that program and by Medicaid — low-income groups that generally have more health needs than others.
The study was funded by the Centers for Medicare & Medicaid Services, the Robert Wood Johnson Foundation of Plainsboro, N.J., and the California HealthCare Foundation.
The researchers noted they had incomplete medical records for some children, no children from rural areas were included, and more than half the families asked to participate didn't respond.
Mangione-Smith and the other experts said they hope the new findings will lead to action to address the shortcomings. Hagan said doctors can do more to keep up with the latest care guidelines. But he said they can't solve all the problems, such as insurance plans that don't cover crucial screenings and the inadequate time pediatricians have to spend with each child.
Another big challenge, Mangione-Smith said, is to change pediatrician training, which now focuses on treating acute illnesses in a hospital.
___
On the Net: http://www.nejm.org
American Academy of Pediatrics: http://www.aap.org/
Agency Pollution cuts Europe lifespans
Wed, 10 Oct 2007 12:33:47 GMTBy DUSAN STOJANOVIC, Associated Press Writer
BELGRADE, Serbia - Poor air and water quality, and environmental changes blamed on global warming, have cut Europeans' life expectancy by nearly a year, Europe's environmental agency warned Wednesday.
More must be done — fast — to reduce greenhouse gas emissions and to improve air and water quality, the European Environment Agency said in a 400-page report presented at a ministerial conference held in Serbia.
Hundreds of thousands of people across Europe are dying prematurely because of air pollution, it said. "The estimated annual loss of life is significantly greater than that due to car accidents," the report said.
At this rate, life expectancy in western and central Europe will be shorter by nearly a year, it said. The current average age expectancy in western and central Europe is 70 for men and 74 for women.
The report also warned of the risks to the development of children.
Pollution is "similarly bleak" across eastern Europe, mostly from vehicle gas emissions and the expansion of industry in ex-Soviet nations, the report said.
Also, more than 100 million people in the region still do not have access to safe drinking water, it said.
The emission of greenhouse gases — on the rise across Europe — has contributed to global warming, the report said, citing overfishing and damage to crops as key risks facing the continent as climate change upsets Europe's ecosystems.
"Climate change is likely to affect seas and coasts, including marine organisms," the report said.
Emissions must be reduced by up to 50 percent by 2050 to limit rises in the earth's temperature — the target proposed by the EU as necessary to avert major climate changes in the future, the report noted.
"We need to further strengthen the will to act on environmental issues across the pan-European region," the agency's director, Jacqueline McGlade, said at the opening of the conference attended by environment officials from 53 countries.
"This requires a better understanding of the problems we face, their nature, and distribution across societies and generations," McGlade said. "Analysis, assessment, communication and education will help overcome this 'information gap' and will better equip those who need to act."
___
On the Net:
http://www.eea.europa.eu/pan-european/fourth-assessment
Kids have trouble keeping weight off
Wed, 10 Oct 2007 10:27:59 GMTBy CHERYL WITTENAUER, Associated Press Writer
ST. LOUIS - Heavy children who lost weight kept the pounds off better through weight maintenance follow-up, but even that wasn't terribly successful over two years, researchers reported.
The less-than-perfect results underscore the challenge in fighting the nation's obesity epidemic. About 34 percent of American children are overweight.
A team led by researchers at Washington University School of Medicine in St. Louis found that obese children who lost weight kept it off if they were in a maintenance program, but its effectiveness waned over time.
The research involving 150 overweight 7- to 12-year-olds is one of the first large-scale studies to evaluate the long-term effects of weight-loss maintenance strategies in children.
The study, which appeared in Wednesday's Journal of the American Medical Association, also is the first to look at whether heavy kids benefited from being encouraged to play with more physically active peers, cope with teasing, and develop an improved body image.
"We know from the adult field that the biggest challenge is not losing weight — it's keeping it off in the long term," said lead author Denise Wilfley, who heads the weight management program at Washington University.
Kids face the same struggle, she said.
The researchers studied obese youngsters from 1999-2004 at a university clinic in San Diego, where Wilfley used to teach. The children weighed at least 65 percent more than their recommended weight. All of the children in the study also had at least one parent who was overweight.
Each child and parent went through a five-month weight-loss program that set goals and emphasized healthy eating and exercise. They were also counseled by behavioral therapists.
On average, after five months, the children lost about 11 percent of their weight. They were then randomly assigned to one of three groups for four months.
One group was given no further instruction. Another group focused on self-monitoring and vigilance and used other behavior skills, trying to lose weight right away if they regained it.
In the third group, the youngsters were guided into play dates that involved physical activity and healthy eating; they were encouraged to make friends with more physically active peers. They also were counseled on body image and how to cope with teasing.
Researchers checked progress after one year and again after two years.
Those in the behavior skills and social groups were better able to keep weight off in the short term than those who had no intervention. However, the effects waned somewhat during follow-up. The kids left to their own devices regained their lost pounds, and then some, after two years.
The best outcome was for socially adept children who were encouraged to change their playmate networks. Most of those children were able to maintain nearly the same weight they had after the weight-loss program.
More work needs to be done to combine the best of the approaches, Wilfley said, perhaps extending the time spent teaching skills to maintain weight.
The alarming number of obese kids means researchers have to develop better ways of helping them lose and keep the pounds off, Wilfley said.
She plans to pursue the idea that spending time with healthy and physically active peers can help kids control their weight over the long haul.
Dr. David Ludwig of Children's Hospital in Boston praised the study's family-based effort. However, he said it wasn't large enough to "make a confident, definitive statement about which approach is better" at maintaining weight loss.
Terry Huang, childhood obesity director at the National Institutes of Health, which funded the study, said the social group's better results are exciting.
"It's not enough to focus on behavior modification," he said. "We have to start looking at obesity in the social context."
For two San Diego teens, the strategies were helpful.
As a chubby second-grader, "I used to look at myself in the mirror, and think, 'Oh, I'm so fat,'" said Katie Roetker, now 15. "Most days I look in the mirror and think, 'looking good.'"
Katie, who took part in the new study, eats more fruits, vegetables and grains. She has given up fast food, and walks and takes dance classes.
Claire Carlson, 17, was nearly 30 pounds overweight when she was part of a pilot for the study in 1999.
Now, she says, "Eating healthy and exercising is second nature to me."
She's on the school swim team and surfs almost daily.
___
On the Net:
JAMA: http://jama.ama-assn.org
