Narrowed Leg Arteries Disable Women Faster Than Men: Study

Women coping with peripheral arterial disease (PAD) in the legs appear to lose mobility faster than men, new research reveals. PAD is marked by narrowing and blockages of the peripheral arteries, usually those in the legs and pelvis. The most common symptoms are pain, cramping and tiredness in the leg or hip muscles when walking or climbing stairs symptoms that go away during rest. "The bottom line is that among those with lower extremity PAD, women have faster declines in mobility and functional performance compared to men," said study author Mary M. McDermott, a professor of medicine.

"This may be related to gender differences in calf muscle, as women tend to have less calf muscle compared to men," McDermott added. She and her colleagues report their findinsg in the Feb. 8 issue of the Journal of the American College of Cardiology. Both the researchers and the American Heart Association note that an estimated 8 million American men and women are affected by lower extremity PAD, with disease prevalence being split about equally across genders. To examine whether disease progression differs among men and women, between 2002 and 2009 McDermott and her team tracked the progress of 380 male and female patients with PAD of the legs in the Chicago area.

All the participants were 59 and older. Over a four-year period, annual mobility assessments were conducted during which each patient was asked to complete a quarter mile, six-minute walk, as well as a four-minute speed test, to observe the development of disability. Changes in calf muscle measurements and characteristics were also noted, alongside knee extension strength. Overall, the research team determined that after adjusting for age, women fared more poorly than men over the course of the study. As the study period unfolded, they noted that women ended up walking less per week and had more difficulty walking the quarter-mile.

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Gene Therapy Shows Potential Against Heart Failure

By substituting a healthy gene for a defective one, scientists were able to partially restore the heart's ability to pump in 39 heart failure patients, researchers report. "This is the first time gene therapy has been tested and shown to improve outcomes for patients with advanced heart failure," study lead author Dr. Donna Mancini, professor of medicine and the Sudhir Choudhrie professor of cardiology at Columbia University College of Physicians and Surgeons in New York City, said in a university news release.

"The therapy works by replenishing levels of an enzyme necessary for the heart to pump more efficiently by introducing the gene for SERCA2a, which is depressed in these patients. If these results are confirmed in future trials, this approach could be an alternative to heart transplant for patients without any other options," she added. Mancini presented the results Monday at the annual meeting of the American Heart Association (AHA) in Chicago. The gene for SERCA2a raises levels of the enzyme back to where the heart can pump more efficiently. The enzyme regulates calcium cycling, which, in turn, is involved in how well the heart contracts, the researchers said.

"Heart failure is a defect in contractility related to calcium cycling," explained Dr. Robert Eckel, past president of the AHA and professor of medicine at the University of Colorado Denver. The study authors hope that, if replicated in larger trials, the gene therapy treatment could actually delay or obviate the need for heart transplants in patients with heart failure. "There are a lot of treatments for heart failure but at some point patients stop responding and then the prognosis is poor," said Dr. Rita Redberg, AHA spokeswoman and professor of medicine at the University of California, San Francisco. After that, the only option is a transplant.

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High Cholesterol in Middle Age May Not Raise Dementia Risk for Women

For years, doctors have been saying that keeping your cholesterol levels in check as you age is good for your brain as well as your heart, but a new study suggests the connection between cholesterol and dementia later in life isn't quite so clear-cut. After more than 1,400 Swedish women followed for 32 years, Johns Hopkins researchers found that those with high cholesterol at mid-life were at no greater risk of developing Alzheimer's and other types of dementia than women with lower levels. In addition, the women whose cholesterol levels decreased the most from middle to older age were 2.5 times more likely to develop dementia than those whose levels increased or stayed the same.

Both cell and animal studies have suggested that high cholesterol contributes to Alzheimer's disease, the researchers noted, but they stressed that the relationship between cholesterol and dementia may vary over a lifetime. "Our findings highlight how risk factors can change over the course of a person's life span," said Michelle M. Mielke, an assistant professor of psychiatry at Hopkins and lead author of the study, which was published online Nov. 10 in the journal Neurology. "My biggest worry is that people will look at these results and decide that cholesterol doesn't matter, but that's not what we're saying," Mielke added.

"We know that high cholesterol is a very strong risk factor for cardiovascular disease and still needs to be treated with diet, exercise and possibly medication." Mielke added that it was unclear why a decline in cholesterol levels in old age was linked to a higher risk of dementia, but said it might be an early part of the disease process. "As people start to develop symptoms, they often forget to eat and start losing weight, and that may be why their cholesterol goes down." For the study, Mielke and her colleagues examined data from the Prospective Population Study of Women, which began in 1968 and consisted of 1,462 Swedish women between the ages of 38 and 60.

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Fish Oil Might Help Fight Gum Disease

Eating even moderate amounts of omega-3 fatty acids, typically found in foods such as salmon and other fatty fish, may help ward off gum disease, new research suggests. Researchers divided nearly 9,200 adults aged 20 and up participating in the National Health and Nutrition Examination Survey between 1999 and 2004 into three groups based on their consumption of omega-3 fatty acids. Consumption was assessed by asking participants to recall exactly what they'd eaten during the prior 24 hours. Dental exams showed participants in the middle and upper third for omega-3 fatty acid consumption were between 23 percent and 30 percent less likely to have gum disease than those who consumed the least amount of omega-3 fatty acids.

Specifically, the researchers found that the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were associated with less gum disease. The association with linolenic acid (LNA) was not statistically significant. "Eating a very feasible amount of fatty fish seems to have a lot of benefit," said senior study author Dr. Kenneth Mukamal, an associate professor of medicine at Harvard Medical School. "But we found no benefits to eating tons of this stuff." Since the study was a snapshot of a single day's diet, Mukamal said researchers could not determine exactly how much fish oil people should consume regularly.

The following guidelines from major organizations such as the American Heart Association, which recommends eating fatty fish at least twice a week, is probably a good idea, not just for gum disease but for overall health, they noted. "There are a lot of benefits of omega-3 fatty acids. We have good evidence they prevent sudden death caused by heart rhythm disturbances. We have some evidence omega-3 fatty acids can reduce the risk of heart attacks and stroke," Mukamal said. "This is a great example of another potential benefit." In the study, researchers took into account other factors that could affect the likelihood of having gum disease, such as age, income, education and other health and socioeconomic factors.

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New CPR Guidelines Emphasize Compressions First

Don't fret about mouth-to-mouth. The average, untrained person can still save a life by focusing on chest compressions first, say new guidelines from the American Heart Association. The simplified form of cardiopulmonary resuscitation, or CPR, focuses on giving chest compressions to keep the blood and the oxygen in the blood flowing to the heart and brain. The group's advice comes on the heels of studies in the past year trumpeting that a compression-only approach is as good or better than compression plus mouth-to-mouth. It updates guidelines from 2005.

"For a variety of reasons, when someone suddenly collapses in cardiac arrest, people often don't start any type of CPR, and one of the barriers, we believe, is that people think it's fairly complicated to do CPR," explained Dr. Michael Sayre, co-author of the new guidelines and chairman of the American Heart Association's emergency cardiovascular care committee. "But chest compressions alone are easy, and anyone can do it," he said. "Chest compressions actually act like an artificial heart, pumping blood to the heart and brain," Sayre noted. "And, that blood often will have a reserve of oxygen."

The American Heart Association recommends that if an adult is unresponsive and not breathing or is having occasional unusual breaths that sound like gasping, any bystander should first call 911 and then begin chest compressions. If someone else is nearby, send that person in search of an automatic external defibrillator, a device that can shock the heart back into normal rhythm. "To give the victim the best chance of survival, three actions must occur within the first moments of a cardiac arrest: activation of the EMS system, provision of CPR and operation of a defibrillator," the new guidelines state.

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Dental Care Linked to Heart Health in Older Women

Older women who get regular dental care are about one-third less likely to suffer from heart disease than those who don't, new findings suggest. The study doesn't prove that dental care directly improves the heart health of women by lowering the risk of conditions like heart attack and stroke, and dental care seemed to have no benefit for men at all in terms of heart disease, but even so, the study authors were still impressed by the findings. The study, which was released online Sept. 29 in advance of publication in an upcoming print issue of Health Economics, analyzed the medical records of nearly 7,000 people aged 44 to 88 who had participated in another study. The data from that study had been collected between 1996 and 2004.

The authors of the new study came to their conclusions after reviewing the data and adjusting the numbers so they wouldn't be thrown off by large or small numbers of people who were, among other things, overweight or users of alcohol and tobacco. "We think the findings reflect differences in how men and women develop cardiovascular disease," study co-author Dr. Stephen Brown, a obstetrician/ gynecologist resident at West Virginia University, said in a news release from the University of California at Berkeley. "Other studies suggest that estrogen has a protective effect against heart disease because it helps prevent the development of atherosclerosis. It's not until women hit menopause, around age 50 to 55, that they start catching up with men."

Dr. Maria Emanuel Ryan, a professor of oral biology and pathology at Stony Brook University in Stony Brook, N.Y., said she has seen signs of a link between dental care and heart disease in her own practice. The study, she said, "confirms the findings of some of the studies conducted in the insurance industry, which suggest that the medical costs for cardiac care and diabetes are reduced in patients who have regular dental visits." There does appear to be a connection between gum disease, in particular, and heart disease. Research suggests that chronic inflammation causes heart disease, Ryan noted, and gum disease "is the most common chronic inflammatory condition in the world. Unfortunately, periodontitis or gum disease is often a silent disease that goes undetected and untreated."

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Heartbreak Puts Brakes on Heart

Waiting for another person's opinion of you will slow your heart, and its rate will dip even further if you get rejected, a new Dutch study has found. "Unexpected social rejection could literally feel 'heartbreaking,' as reflected by a transient slowing of heart rate," the study authors wrote in a news release from the Association for Psychological Science. In the study, volunteers were asked to submit photos of themselves and told that students at another university would look at the images and decide whether they liked the person in the photos. This was a ruse: no one was actually looking at them. But the volunteers didn't know that, and returned later to look at a series of photos of the college students who were ostensibly judging them and guess what their opinions of the volunteers had been.

Using an electrocardiogram, researchers then measured the heart rates of the volunteers as they discovered what the other students supposedly thought of them. The researchers found that the heart rates of the volunteers fell as they waited to learn about a supposed judgment. If they were rejected, their heart rates slowed even more, and they slowed the most in those who expected the other person would like them. Bregtje Gunther Moor and colleagues at the University of Amsterdam and Leiden University in the Netherlands released their study online recently in advance of publication in an upcoming print issue of the journal Psychological Science.

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Surgery May Be Best for Irregular Heartbeat in Young

Young people with the kind of irregular heartbeat known as atrial fibrillation may be better off undergoing surgery to fix the problem instead of taking medication first, a new study suggests. Atrial fibrillation, which causes a person's pulse rate to change from minute to minute, can boost the risk of stroke and cause other problems. The condition is rare in younger people and can occur for no known reason. There are a number of treatments for atrial fibrillation, including medication, cardioversion and catheter ablation. A heart specialist who's familiar with the new study findings said ablation is indeed a worthwhile alternative. "Younger patients tend to respond very well to this therapy," said Dr. John Day, medical director of heart rhythm services at Intermountain Medical Center in Murray, Utah.

In the study, which was released online Sept. 21 in advance of publication in the journal Circulation: Arrhythmia & Electrophysiology, researchers examined the medical records of 1,548 patients who underwent catheter ablation between 2000 and 2008 in the University of Pennsylvania Health System. The average age of the patients was 56 years, and 70 percent were men. The investigators found that younger patients had fewer complications than older ones and did just as well after the surgery. A year after surgery, 87 percent of the patients under the age of 45 had experienced little or no atrial fibrillation.

Why choose the surgery instead of medication? "While atrial fibrillation is more common with increasing age, clinical experience has suggested that younger patients tend to be more symptomatic and less willing to take long-term medications," Dr. Peter Leong-Sit, study lead author and an arrhythmia physician at London Health Sciences-University Hospital in London, Ontario, Canada, said in a news release from the American Heart Association. The surgery isn't cheap. It can cost $30,000-$40,000, Day noted. But studies have shown it can be cheaper in the long run if the alternative is a lifetime of medications and complicated testing and care, he added.

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High Blood Sugar Levels Increase Infection Risk From General Surgery

High blood sugar levels can increase the risk of surgical site infections in patients having general surgery, researchers report. Doctors have long been aware that people with diabetes are more prone to surgical infections, and the relationship between high blood sugar and increased risk of infection after surgery is well known in heart and intensive care unit surgery, where blood sugar is carefully monitored. But this appears to be the first study to quantify the risk after general surgery, noted the study authors, from Albany Medical College in New York.

"We wanted to find out how much increased glucose in your blood had a role in infection in general surgery," said lead researcher Ashar Ata, from the College's Department of Surgery. "Surprisingly, we did find that by the time your glucose is higher than 140 milligrams per deciliter, the infection went from 1.8 percent to almost 10 percent." When blood sugar levels reach that point, medical staff should intervene to control them, Ata said, adding, "We found the higher the blood glucose, starting at about 110 milligrams per deciliter, the more likely you are to have an infection."

The report is published in the September issue of the Archives of Surgery. The procedures Ata's group looked at included appendectomy, colon surgery, hemorrhoid removal and gallbladder removal, he said. These operations all fall under the definition of general surgery. For the study, Ata's team looked at medical records of 2,090 patients who had had general or vascular surgery between Nov. 1, 2006, and April 30, 2009. Among these patients, the researchers studied the blood sugar levels of 1,561 patients, including those who had vascular surgery, colorectal surgery and other types of general surgery.

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Clearing Kids for Sports Participation Sparks Conflicts

Most teenagers think they're invincible, and that goes double for talented teenage athletes. They're young, immortal, at the top of their game, the envy of their friends. So when news hits that an apparently healthy, high school or college athlete has dropped dead in the midst of playing his or her favorite sport, millions of parents get understandably anxious. The uppermost question becomes: Should my child be screened before participating in sports? What tests are needed? And how can we be sure that he or she is truly healthy enough to compete? Everyone agrees that a medical checkup before participating in sports is crucial. But the agreement seems to stop there. At the core of the conflict over further testing is how extensively young athletes' hearts should be tested before they're cleared for athletic participation.

"I think everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics," said Dr. Paul Thompson, the director of preventive cardiology at Hartford Hospital in Connecticut, who helped write a joint position statement in 2007 from the American College of Sports Medicine and the American Heart Association. That statement recommends cardiovascular screening for high school and college athletes before they start participating in athletics and at two- to four-year intervals. The screening should include a family history, a personal history and an exam "focused on detecting conditions associated with exercise-related events," according to the groups' recommendation.

But, there's more: "The AHA does not recommend routine, additional noninvasive testing such as a routine EKG." The American Academy of Pediatrics seems to agree. "Every athlete should have a thorough history [taken] from the athlete as well as the athlete's family," explained Dr. Reginald Washington, a pediatric cardiologist and chief medical officer at Rocky Mountain Hospital for Children in Denver and past chairman of the academy's committee on sports medicine and fitness.The doctor should ask about any chest pain and dizziness, and whether the athlete has ever passed out or experienced a racing or unusual heartbeat, Washington said. The physician should also ask if the athlete's parents have had early heart disease, before age 55 for a man and 65 for a woman. And the physical exam, he said, should be thorough and include listening to the heart, taking blood pressure and feeling the pulse.

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Unvaccinated Teen's Life Forever Changed

Carl Buher came home from the football game feeling rotten. A strong, healthy, 14-year-old high school freshman, Carl had attended a day's worth of school and then played in the game, but it felt as if he were coming down with the flu. That made sense: A lot of his teammates had recently had the flu, and he figured they'd just passed it on to him. So he came home, ate, did his homework and went to bed, recalled Carl's mother, Lori Buher of La Conner, Wash. When she woke him up in the morning, Carl told her he'd been up all night vomiting. "We figured he had the flu, so he stayed home from school," Buher said. The first sign that Carl might be sicker than they thought came in the form of purple bruises that began to form, first on his face and then down his arms and legs. By 2 p.m., Buher took her son to the doctor, concerned for his health.

The doctor diagnosed Carl quickly and, as it turned out, accurately: The teen had contracted meningococcal meningitis. The diagnosis took Buher by surprise. "He had none of the symptoms you hear about," she said. "No stiff neck. No terrible headache. No high fever." The family physician sent Carl to the local hospital's emergency room. Within hours he was being airlifted to Seattle Children's Hospital. "His heart stopped twice on the helicopter," Buher said. "They had to revive him." This was in 2003, and Buher knew about meningitis and knew that a vaccine was available to prevent it. But at the time, the vaccine Menomune wasn't recommended for kids Carl's age. Teens headed for college were supposed to get the vaccine, but even that was a shaky proposition.

Buher's two college-age kids were on a waiting list for Menomune vaccination but hadn't received it yet because supplies were short. Now her son Carl was incredibly sick with the disease. She and her husband hurriedly made the hour's drive to Seattle. "When we got there, they had a social worker waiting to help us prepare for his death," she remembers. "It was so overwhelming." Doctors put Carl in a drug-induced coma, in which he lingered for five weeks. His mother recalls that he was given more than 25 different medications to keep his body functioning. Nonetheless, meningitis ravaged Carl's body. He had to have both legs amputated below the knee, and he also lost three fingers. The purple bruising turned out to be his skin dying, which led to gangrene. Carl endured skin grafts all over his body, 13 in all, and still bears the scars. His weight fell from 185 to 119 pounds.

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Quality of Care After Joint Surgery May Affect Heart Health

The quality of care a patient receives immediately after orthopedic surgery has a major impact on long-term heart health, a new study shows. A team of French researchers checked troponin levels in 378 patients for three days after they had orthopedic surgery, which includes procedures such as joint replacement. Troponin is a protein that's measured to determine whether physiologic stress related to surgery has caused damage to the heart. Dr. Sylvain Ausset, of Percy Military Hospital in Clamart, France, and colleagues focused on troponin levels to detect myocardial ischemia, which correlated with worse long-term cardiac outcomes.

The researchers then modified postoperative care to reduce events believed to lead to increased episodes of angina based on elevated troponin levels. Doing so lowered the incidence of cardiac problems months, and even years, later, they found.The methods used to improve quality of care included tighter control of oxygen and glucose levels in patients' blood, along with consistency and continuity of care as hospital staff monitored and cared for patients, according to the report published in the October issue of Anesthesiology.

"An improvement of quality of postoperative care results in a twofold decrease of postoperative myocardial ischemia and a fourfold decrease of major cardiac events later on," Ausset said in a news release from the American Society of Anesthesiologists. The findings could lead to new or improved clinical guidelines, according to an accompanying editorial written by Dr. Don Poldermans, of Erasmus Medical Center in Rotterdam, the Netherlands.

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