THE STUDY AND RESULTS half of all heart attacks occur in people with normal levels of lipids, or fats, in the blood.  Since common cholesterol testing does not provide an indication of these  patients' risk for heart problems, researchers have been looking for other significant markers.  This study looked at markers for inflammation in the coronary arteries, because it has been strongly linked to the development of cardiovascular disease. 

The Harvard University researchers froze blood samples from more than 28,000 healthy pose-menopausal women and monitored the women for three years, They then analyzed the blood samples of 122 women in the group who subsequently suffered a heart attack or stroke, had undergone a heart bypass or angioplasty or died of cardiovascular disease.  They also analyzed blood samples of 244 other women who did not suffer any cardiovascular problems.   The  researchers looked at 12 blood markers, including cholesterol and an indicator of  inflammation called high sensitivity C-reactive protein.  High levels of that protein turned out to be the best predictor of the risk of cardiovascular disease even better than cholesterol screening.

        What's new This is the first large-scale, prospective study to look at the possible benefit of checking inflammation markers in the blood.  In addition, this is the first large study of screening for high sensitivity C-reactive protein in women.

         CAVEATS the study looked only at post-menopausal women and thus the results may not apply to younger women.  Although the study does not specifically say then new findings would be relevant to men, the authors note that the earlier, smaller studies that also showed similar connections to arterial inflammation have largely focused on men.  Also, since the blood samples were taken when the study began, it is not known how the women's blood markers might have changed over the course of the study.

        BOTTOM LINE The study suggests that screening for high sensitivity C-reactive protein in addition to cholesterol testing would improve the chances of finding and treating women at risk for heart disease.  The authors also note that there are several commercial tests for C-reactive protein, but suggest that the one most recently approved by the Food and Drug Administration is the most reliable.


A Blood Pressure drug relieves headaches from mild hypertension.

           The study and results headache has long been associated with severe high blood pressure, but studies have not consistently shown it was a symptom of mild to moderate hypertension.  These researchers pooled data from seven studies investigating whether mild to moderate high blood pressure is associated with headache and whether the blood pressure drug irbesartan (Avapro) could provide safe relief.  These studies included a total of 2,673 predominantly white adults with a 142 systolic over 92 diastolic blood pressure (or stage I mild hypertension).

        Participants received either irbesartan or a sham pill.  The patients were regularly given physical exams and questioned about headaches or adverse reactions from the treatment.  Younger women who received the sham pill seemed to have the most headaches, while patients receiving irbesartan had fewer headaches.  The researchers also associated increasing diastolic, but not systolic, blood pressure with new or worsening episodes of headache.

       What's New this study demonstrates a direct association between headache and milled to moderate high blood pressure by showing that those who receive treatment for this condition have fewer headaches than those who do not receive treatment.  The treatment I s with irbesartan, which belongs to a new class of drugs known as angiotensin II receptor blockers (ARBs).

      Caveats Bristor-Myers Squibb Co. the manufacturer of  Avapro, funded the study.  In addition, headache reports were based on the patient's memories.  The results need to be verified in other ethnic groups.

      Bottom Line people with mild to moderate hypertension may reduce associated headache by taking irbesartan.

      Find this study June 12 issue of the Archives of Internal Medicine or http://archinte.ama-assn.org/.




Women who give birth prematurely are likelier to do so in later births.

            THE STUDY AND RESULTS Drawing on fetal death and birth certificates from Georgia from 1980 through 1995, researchers from the Centers for Disease Control and Prevention created and analyzed pregnancy histories for nearly 180,000 women who delivered first and second children in single births at 20 to 44 weeks' gestation. Among women who delivered their first children prematurely (defined as 37 weeks or earlier), 20 percent of white women and 26 percent of  black women delivered prematurely again in the second pregnancy.  Most babies are delivered at full term' overall, only 10 percent of white newborn and 18 percent of black newborns in this country are delivered prematurely, according to 1997 figures.
         WHAT'S NEW this study shows that recurrent premature delivery accounts for a substantial portion of all premature births.
         CAVEATS because the study used population-based date, researchers were unable to distinguish between spontaneous and medically dictated preterm births.  This is important, the study says, because rates of recurrence differ widely between these categories.
         BOTTOM LINE prior pre-term delivery is a key risk factor for premature births  in subsequent pregnancies.

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