Lowered HRT Use May Have Cut Heart Attacks

(HealthDay News) -- The decline in the use of hormone replacement therapy (HRT) to treat menopause symptoms has been mirrored by a drop in the rate of Heart attacks among American women, a new study finds.

But there's been no decrease in the rate of strokes, researchers noted.

Hormone replacement therapy was widely used to treat menopause symptoms until 2002, when researchers published a study that said HRT increased the risk of heart attack. After that, the use of HRT among women ages 50-69 decreased from more than 30 percent to less than 15 percent, the researchers said.

In this new study, the researchers examined U.S. death records, hospital discharge data and national surveys of medication usage between 1990 and 2005 for women ages 40-79. The analysis revealed a decrease in heart attacks but no reduction in the number of hospitalizations or deaths from stroke.

"We were surprised that HRT had such divergent effects on stroke and acute myocardial infarction (heart attack) in the overall population," lead author Dr. Kanaka Shetty, of the RAND Corporation in Santa Monica, Calif., said in a news release.

The study appears in the May issue of the journal Medical Care.

The decrease in heart attacks among American women may be due to factors other than reduced use of HRT, suggested Dr. Nieca Goldberg, a cardiologist at Total Heart Care in New York City whose practice focuses primarily on women.

"The reduction in hormone therapy coincided with the American Heart Association's and National Heart, Lung, and Blood Institute's women and heart disease awareness campaigns," Goldberg said in a news release.

"The lower rate of heart attacks may be due to better screening for heart disease risk factors and better awareness of women's heart attack symptoms by physicians," Goldberg said. "It's premature to attribute the decline in heart attack rates to the decline in hormone therapy."

More information
The U.S. National Institutes of Health has more about HRT.

Children of Centenarians Face Lower Heart Risks

(HealthDay News) -- Longevity runs in families, the saying goes, and new research shows there may be genetic and physiological reasons for the phenomenon.

The children of people who live to 100 and beyond are themselves much less likely to develop cardiovascular diseases, such as heart disease and stroke, and even diabetes, researchers found.

But they aren't impervious to non-cardiovascular health problems, such as cancer, dementia and depression.

The findings stem from an analysis of health data collected over a decade by the New England Centenarian Study, which focuses on people aged 97 and older and their family members. It's the first study to track the health of children of centenarians as they age.

"This confirms what we were already suspecting, and definitely suggests that there is a genetic component to the ability to create exceptional longevity," said study author Emily R. Adams, a third-year medical student at Boston University School of Medicine.

Adams and her Boston University colleagues, Dr. Dellara F. Terry and Dr. Thomas Perls, director of the New England Centenarian Study, presented their findings in the November issue of the Journal of the American Geriatrics Society.

For the 10-year study, initial and follow-up questionnaires regarding health status were presented to 440 children of centenarians, as well as to 192 men and women whose parents had not lived past 100. The average age of the participants was 72 when the study began in 1997.

The researchers found that compared to the average adult, children of centenarians had a 78 percent lower risk for a heart attack, an 83 percent lower risk for a stroke, and an 86 percent lower risk for developing diabetes.

They were also 81 percent less likely to die during the course of the study.

The researchers said the findings generally reinforce the important role that genetics play in reaching extreme old age, and specifically highlight the cardiovascular leg up children of centenarians appear to inherit from their parents.

But, Adams added, while good genetic lineage may portend a longer life, it doesn't guarantee protection against all diseases.

"You might expect that centenarian offspring would do better as they age, and that is true. They do follow a different trajectory, and go down a less steep slope," she said.

But, Adams noted that the study found that children of centenarians do not, for example, experience significantly lower rates of arrhythmias, cancer, macular degeneration, dementia, depression, fractures, osteoporosis and thyroid disease.

"It's really with the vascular diseases that they fared better," she said.

Jay Olshansky, a senior research scientist at the University of Chicago's Center on Aging, said future work in this arena will focus on trying to isolate the mechanism behind genetic longevity.

"This study looked at outcomes and is directly in line with what you would expect," said Olshansky, who's also a professor with the university's school of public health. "But that is where this research is going next -- to find out how this very strong genetic component to living long plays out.

"But the bottom line," he added, "is that we already know that the genes that are associated with exceptional longevity already exist, and that they are concentrated in subgroups of the population. And the rest of us don't have those genes, or don't have all of them. Those who do have won the genetic lottery for making it out to exceptional old age. And, unfortunately, if you haven't won, there's no chance you can make it."

More information
To learn more about centenarians, visit the Howard Hughes Medical Institute.

Heavy Traffic Can Be Heartbreaking

(HealthDay News) -- The decline in highway traffic that was brought on by last summer's spike in gas prices may be a boon to heart health.

That's because automobile emissions are among a long list of risk factors for heart disease and stroke.

"There's a very coherent and consistent body of data that links particulate air pollution with cardiovascular disease and premature death," said Dr. Ted Schettler, science director of the Science and Environmental Health Network, an environmental and public health advocacy group.

Among the latest evidence: a German study published recently in Circulation: Journal of the American Heart Association, which found that people who live near heavy traffic are more likely to develop atherosclerosis, or hardening of the arteries, which can boost the risk of heart disease.

Atherosclerosis is a progressive disease that begins with damage to the lining of the arteries. Over time, the arteries accumulate plaque, a combination of fat, cholesterol, calcium and other substances. This causes the arteries to become rigid and narrow, impeding the flow of oxygen-rich blood to the heart and other parts of the body. This can lead to a heart attack, stroke or even death, according to the U.S. National Heart, Lung, and Blood Institute.

In 2004, the American Heart Association issued its first official statement on air pollution and cardiovascular disease. In reviewing the scientific evidence, an expert panel concluded that short-term exposure to elevated particulate matter, which includes motor vehicle emissions, "significantly contributes to increased acute cardiovascular mortality, particularly in certain at-risk subsets of the population."

The panel further noted that prolonged exposure to elevated levels of air pollution reduced overall life expectancy "on the order of a few years."

To assess the impact of long-term residential traffic exposure on the heart, Dr. Barbara Hoffmann, head of the unit of environmental epidemiology at the University of Duisburg-Essen, and colleagues used "electron-beam computed tomography" to measure calcium build-up in the arteries.

Compared with people who lived more than 200 meters, or 642 feet, from major traffic, the risk of coronary artery calcification was 63 percent higher for people living within 50 meters (160 feet) of heavy traffic, and 34 percent higher for those who were between 51 meters and 100 meters (164 to 328 feet) away. The risk was 8 percent higher for those living 100 meters to 200 meters (328 to 642 feet) away.

Hoffmann compares the damage wrought by traffic fumes to the effects of aging. "Living within 100 meters of a major road compared to people living further away amounts to a similar difference in coronary calcification as six months of aging," she said.

Her team is currently examining all study participants again to determine whether those living close to heavy traffic have suffered a greater increase in coronary calcification during the past five years.

So what can individuals do, short of moving away from heavily traveled roads, to stave off cardiovascular disease?

The best thing is focus on modifiable factors, such as keeping blood pressure and diabetes in check, lowering cholesterol, increasing physical activity and quitting smoking, Hoffmann said.

Reducing air pollution is a larger challenge.

In big U.S. cities, state and local agencies are required to report the Air Quality Index -- a measure of how pristine or polluted the air is -- each day, says AirNow, a federal government Web site on air quality. Depending on the level of concern, people with heart or lung disease, older adults and children may be advised to remain indoors

"That's just a Band-Aid on a public health problem," Schettler said. "Do we want people who have early cardiovascular disease to have to avoid breathing air outside, or do we want to clean up the air?"

More information
For more on the heart-health effects of air pollution, visit the American Heart Association.

Aspirin Doesn't Prevent First Heart Attack, Stroke

(HealthDay News) -- Contradicting current recommendations, a new trial finds that aspirin does not reduce the risk of heart attack and stroke for people with diabetes or peripheral arterial disease.

Aspirin clearly is effective in secondary prevention, reducing the risk for people who already have had a heart attack or stroke, said study author Dr. Jill Belch, a professor of vascular medicine at the University of Dundee in Scotland. Her report was published in the online issue of the BMJ.

However, in the study of 1,276 people who had not yet suffered a heart attack or stroke but were at high risk because they had diabetes or peripheral arterial disease (partial blockage of leg arteries), "we found that they did not benefit from daily aspirin," Belch said. The study showed that aspirin is ineffective in primary prevention, she noted.

"The number of heart attacks and strokes was exactly the same over eight years for those taking aspirin and those taking placebo," Belch said.

The same was true of the antioxidants given in the trial, she said, which was no surprise. "All the antioxidant studies over the past 10 years have been negative," Belch said.

Both the American Heart Association and the U.S. government recommend aspirin for people who have not had heart attacks or strokes but are at high risk for cardiovascular trouble because of conditions such as diabetes.

Those recommendations probably should be changed, said Dr. William R. Hiatt, a professor of medicine at the University of Colorado, who wrote an accompanying editorial.

The newly reported study "is consistent with six other studies on primary prevention, and all those studies were negative," Hiatt said.

The current recommendations are based on analysis of studies that found some primary prevention benefit in subgroups, he said. "Overall, if you do not have heart disease, the risk of bleeding outweighs any benefit you get from aspirin," Hiatt said.

The U.S. Preventive Services Task Force recommendation for use of aspirin in people at high risk of heart disease cited five studies that included 50,000 people. But its report noted that "no trial showed a significant all-cause mortality difference between aspirin-treated and control groups."

Hiatt said that he served on an advisory committee of the U.S. Food and Drug Administration that reviewed a request in 2003 by Bayer to extending the labeling of aspirin to include primary prevention in heart disease. "We couldn't support that request," he said.

Advertisements urging people to take aspirin to benefit the heart are accurate for those who already have had an event, both Belch and Hiatt said.

"It works if you've already had a heart attack," Belch said. "But there is no proof for primary prevention, no proof at all."

"The evidence is solid that aspirin should be given to people with known heart disease," Hiatt said. "But the evidence for people who have risk factors for heart disease is different."

More information
Risks and possible benefits of aspirin for the heart are reviewed by the U.S. Food and Drug Administration.

Later Use of Clot-Buster After Stroke Possible: Study

(HealthDay News) -- European researchers who showed that the clot-dissolving drug tPA could safely be used within three hours after a stroke now say the limit can be extended to four-and-a-half hours.

"We now have a three-hour limit mandated by authorities," said Dr. Nils Wahlgren, a neurology professor at the Karolinska Institute in Sweden and leader of an international group reporting Sunday in the online version of The Lancet. "Our data indicate that it is safe to extend that from three hours to four-and-a-half hours. The risk of hemorrhagic complications is not significantly different from the earlier time limit."

Tissue plasminogen activator (tPA), also known as the drug alteplase, is the approved treatment for the most common kind of stroke, in which a blood clot blocks a brain artery. The three-hour post-stroke time limit has been set because of fears that use of the clot-dissolving drug beyond that period might cause dangerous bleeding or other complications.

The new report is the latest from a study requested by European authorities after doubts arose about the safety of tPA in stroke treatment, which was approved in 1996 by the U.S. Food and Drug Administration. It was approved in 2002 in Europe.

The study compared the outcomes of 664 people who were given tPA between three and four-and-a-half hours after a stroke against almost 12,000 who received the drug within three hours of an attack.

The study found a death rate of 12.7 percent in the following three months for the three-hour group and 12.2 percent for those getting tPA later. In the early group, 58 percent achieved the ability of independent action, compared to 56.3 percent in the later-administration group.

"We recorded no significant differences between the 3- to 4.5-hour cohort and the within 3-hour cohort for any outcome measure," the researchers reported.

The bottom line, according to Wahlgren: "if patient treatment has been delayed, it is still safe to treat a patient beyond the time limit of three hours."

The results were expected to be presented at an international meeting in Stockholm in November, "when we will recommend a change in the guidelines," Wahlgren said. "I expect it would be accepted by the international community, both in the United States and Europe, and in the rest of the world."

But the new results do not necessarily mean an end to the three-hour limit, cautioned Dr. Larry Goldstein, professor of neurology at Duke University and director of the Duke Stroke Center in Durham, N.C.

"They are consistent with a combined analysis done some time ago that suggested we might be able to treat beyond three hours," Goldstein said. "But those were observational studies, as was this one. Controlled trials done to test that belief have not shown benefit."

It will take a change in the current guidelines to alter the three-hour limit, he said, and the overall benefit of tPA is greater when it is given earlier. "The sooner you get blood to the brain, the better," Goldstein said.

More information
There's more on tPA at the American Heart Association.

Antipsychotic Drugs Boost Stroke Risk

(HealthDay News) -- All antipsychotic drugs can increase the risk of stroke, but the risk is greatest among older patients with dementia, British researchers report.

Concerns about the risk of stroke and antipsychotics were first raised in 2002, especially in people with dementia. In 2004, Britain's Committee on Safety of Medicines recommended that antipsychotics not be used in people with dementia. And, in 2005, the U.S. Food and Drug Administration ordered manufacturers of atypical antipsychotics to add a black box warning to their products about the increased risk for stroke.

"Antipsychotics are effective in treating potentially very distressing psychiatric symptoms, but as with all drugs, their use can be associated with a range of benefits and possible side effects," said study author Dr. Ian Douglas, a research fellow at the London School of Hygiene and Tropical Medicine. "This study has further clarified the potential for antipsychotics to increase the risk of stroke."

Both typical (first generation) and atypical (second generation) antipsychotics are associated with an increased risk of stroke, Douglas said. "This risk is substantially higher in patients with dementia than those without. These findings need to be factored into prescribing decisions made by doctors caring for patients with often-distressing and difficult-to-treat psychiatric symptoms."

For the study, Douglas and his colleague Liam Smeeth, a professor of clinical epidemiology, collected data on 6,790 patients who had suffered a stroke and were taking antipsychotic drugs. Patients taking antipsychotic drugs were 1.7 times more likely to have a stroke, and patients with dementia taking antipsychotics were 3.5 times more likely to have a stroke.

The risk for stroke was slightly higher for people taking the newer atypical antipsychotics, compared with people taking the older typical antipsychotics. Atypical antipsychotics include drugs such as Abilify, Clozaril and Zyprexa. Typical antipsychotics include Thorazine, Haldol and Clopixol.

The study authors did not look at the potential mechanisms associated with antipsychotics that cause stroke, or why the risk appears higher with atypical antipsychotics.

"We believe that the risks associated with antipsychotic use in patients with dementia generally outweigh the potential benefits, and, in this patient group, use of antipsychotic drugs should be avoided wherever possible," Douglas said. "For other patients, careful consideration must be given to the likely individual risks and benefits of any prescribing decision."

The findings were published online Aug. 29 in the British Medical Journal.

Dr. Sam Gandy is associate director of the Alzheimer's Disease Research Center at Mount Sinai Medical Center in New York City, and chairman of the Alzheimer's Association's national medical and scientific advisory council. He said the new study addresses an "important topic and elevates the concern about risks of antipsychotics to a whole new level. The FDA [U.S. Food and Drug Administration] might investigate whether availability limitations or warning labeling should be imposed.

More information
To learn more about antipsychotics, visit the National Institute of Mental Health.