Discrimination May Lead to Smoking in Boys

FRIDAY, Jan. 22 (HealthDay News) — Minority teen boys smoke more when they suffer discrimination, but that’s not the case for minority teen girls, a U.S. study finds.

Perceived discrimination had no effect on smoking rates among minority girls aged 12 to 15 and was associated with lower rates of smoking among minority teen girls aged 16 to 19.

“Our findings in girls, especially in the older girls, really surprised us,” study first author Dr. Sarah Wiehe, an assistant professor of pediatrics at the Indiana University School of Medicine, said in a news release from the school. “We do not know why older girls who perceived discrimination were less likely to smoke, but there may be a possibility that they perceived discrimination because they were pregnant and also that they did not smoke due to pregnancy.”

The study included 2,561 black and Hispanic teens, aged 12 to 19, living in low-income households in Baltimore, Boston, Chicago, Los Angeles and New York. About 25% of the teens reported discrimination within the previous six months, and 12% said they’d smoked within the previous 30 days.

Increased smoking by boys who suffer higher levels of discrimination may be caused by increased stress from male-specific targeting by police and business, the study concluded.

“Boys and girls may experience discrimination differently due to where they spend their time and that may account for the differences in whether discrimination was associated with smoking,” Wiehe said. “In other words, the context of discrimination matters. We need to be aware that discrimination is a public health problem for adolescents — one related to major health issues like smoking — and need to actively work to reduce these occurrences.”

The study appears online and in the March print issue of the American Journal of Public Health

ED, Heart Disease May Be Deadly Duo

By Bill Hendrick
WebMD Health News

Reviewed by Laura J. Martin, MD
Latest Mens Health News

* ED, Heart Disease May Be Deadly Duo
* Drug for Enlarged Prostate Approved
* Discrimination May Lead to Smoking in Boys
* Men in Europe Trace Roots to Near East Migrants
* Women’s Scent Triggers Hormone Surge in Men
* Want More News? Sign Up for MedicineNet Newsletters!

March 15, 2010 — Erectile dysfunction is a major warning sign for cardiovascular disease and early death.

The finding comes from placebo-controlled studies comparing randomly selected men with ED and cardiovascular disease and men without ED.

The men with ED and cardiovascular disease were:

* 1.9 times more likely to die from cardiovascular disease
* Twice as likely to have a heart attack
* 1.2 times more likely to be hospitalized for heart failure
* 1.1 times more likely to have a stroke

The researchers say they found that medications like ramipril, an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure, can reduce cardiovascular events but don’t seem to influence the course or development of ED.

“Erectile dysfunction is something that regularly should be addressed in the medical history of patients,” Michael Bohm, MD, lead author of the study and chairman of internal medicine at the University of Saarland in Germany, says in a news release. “It might be a symptom of early atherosclerosis.”

The study included 1,549 male cardiovascular patients in 13 countries. Each was asked if he had ED, and men who answered in the affirmative were then categorized as having mild, mild-to-moderate, moderate, or severe ED. The average follow-up was five years.

Patients in one trial involving 400 men were randomly assigned to take ramipril, telmisartan — an angiotensin II receptor antagonist used to treat hypertension and heart failure — or a combination.

In another, ACE inhibitor-intolerant patients were randomly assigned to take a placebo or telmisartan.

Patients with ED were older and had a higher prevalence of hypertension, stroke, diabetes, and lower urinary track surgery than men without ED. And 55% of men had ED when they entered the trials.

Researchers say deaths from all causes occurred in 11.3% of patients who had ED at the start, but in only 5.6% of people with no ED or only mild problems at baseline.

They report that 16.2% of ED patients died from cardiovascular problems, suffered heart attacks or strokes, or were hospitalized for heart failure. Only 10.3% of men with no or mild ED had similar outcomes.

As ED worsened, risk of death from all causes increased, suggesting that ED identifies men whose cardiovascular disease might be dangerously advanced.

Bohm says that ED is closely associated with conditions that occur in atherosclerosis and vascular problems, such as plaque buildup, which often precedes heart attacks and strokes.

“Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment,” Bohm says. “ED is an early predictor of cardiovascular disease.”

Men with ED are often treated for impotence but not underlying cardiovascular disease, he says, thus placing “a whole segment of men” at increased risk of death.

Therefore, men and their doctors need to view ED as a risk factor, just as they do high blood pressure and cholesterol, he says.

The study is published in the March 15 issue of Circulation: Journal of the American Heart Association.

Placebo effect may be at play in acupuncture studies: analysis

Reuters Health – Acupuncture can bring some relief to people with knee arthritis, but the benefits may be at least partly from a placebo effect, a new research review suggests.

In an analysis of 9 clinical trials from the past 15 years, researchers found that acupuncture generally seemed to improve knee arthritis sufferers’ pain and stiffness in the short term. The patients had osteoarthritis, a degenerative joint disease associated with age, as opposed to arthritis associated with an autoimmune disorder.

However, a closer look showed that the benefits were limited to trials that compared acupuncture with doing nothing or with “usual care,” such as anti-inflammatory medication.

In trials that compared acupuncture with “sham” acupuncture, on the other hand, there was no clear evidence that the real therapy was more effective.

Sham acupuncture is accomplished by using non-penetrating needles, or inserting needles only into the superficial layer of skin, at random sites rather than the specific points used in real acupuncture. In studies that evaluated electro-acupuncture, the sham version involved phony electrodes and “mock” electrical stimulation of acupuncture points.

The point is to keep study participants from knowing whether they were receiving the real or the placebo treatment. This helps separate the specific effects of a therapy from any placebo effects — where people feel better simply because they believe they’ve been treated.

The new findings suggest that the benefits of acupuncture for knee arthritis are at least partly due to patients’ expectations, the study authors report in the Annals of Internal Medicine.

However, that doesn’t mean acupuncture is not worthwhile, according to the researchers, led by Eric Manheimer of the University of Maryland School of Medicine in Baltimore.

Research does suggest that acupuncture has a “genuine biological effect,” and there was evidence in some studies that the real therapy resulted in somewhat better short-term effects than sham acupuncture, the researchers note.

For their study, Manheimer and his colleagues combined the results of nine clinical trials conducted in Europe, the U.S. and Thailand. The trials included a total of more than 3,500 subjects.

Each trial included a patient group that received acupuncture for knee arthritis, as well as a “control” group. In some studies, control patients were placed on a waiting list for acupuncture, while in others they received some standard therapy that acupuncture patients did not. Control patients in other studies received sham acupuncture.

In general, the Manheimer’s team found, only studies that pitted acupuncture against doing nothing, or against standard care, showed clear benefits. The results of the sham-controlled trials were too mixed to show any benefits, according to the researchers.

The investigators do not, however, dismiss the potential benefits of acupuncture for knee arthritis. Indeed, they note, a possible explanation for the mixed results is that sham acupuncture had some actual biological effects.

Given the overall safety of acupuncture, the researchers conclude, patients can still consider it as one option in a “multidisciplinary approach” to treating knee arthritis.

Red yeast rice may lower blood lipid levels

CM NEWS – Replacing daily intake of white rice with red yeast rice may have a positive lipid-lowering effects in patients with primary hyperlipidemia, a meta-analysis of 93 randomized trials concludes.

The study was released in Chinese Medicine journal and was a joint study by alternative medicine experts in Norway and traditional Chinese medicine researchers in Shanghai and Beijing.

The meta study analyzed data from 93 randomized trials which include a total of 9625 participants. Researchers find that hyperlipidemia patients who have consumed red rice show significant reduction of serum total cholesterol levels (weighted mean difference -0.91 mmol/L, 95% confidence interval -1.12 to -0.71), triglycerides levels (-0.41 mmol/L, -0.6 to -0.22), and LDL-cholesterol levels (-0.73 mmol/L, -1.02 to -0.043), and increase of HDL-cholesterol levels (0.15 mmol/L, 0.09 to 0.22), compared to placebo groups.

Researchers emphasize that the positive effect on lipid levels by red rice shown by these studies indicates short term benefits. Whether red rice should be recommended as an alternative treatments for primary hyperlipidemia requires further studies.

According to Medline, red yeast rice contains several compounds collectively known as Monacolins, substances known to inhibit cholesterol synthesis. One of these, “Monacolin K” is a potent inhibitor of HMG-CoA reductase, and is also known as Mevinolin or Lovastatin (Mevacor®, a drug produced by Merck & Co., Inc).

Medline also says:

There is limited evidence about the side effects of red yeast. Mild headache and abdominal discomfort can occur. Side effects may be similar to those for the prescription druglovastatin (Mevacor®). Heartburn, gas, bloating, muscle pain or damage, dizziness, asthma, and kidney problems are possible. People with liver disease should not use red yeast products.

In theory, red yeast may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. A metabolite of Monascus called mycotoxin citrinin (CTN) in fermentation may be harmful.

Hypertension Drugs May Cut Alzheimer’s Risk

By Bill Hendrick
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 12, 2010 — Drugs commonly used to treat high blood pressure and heart disease may reduce the risk of dementia and Alzheimer’s disease, a new study suggests.

Boston University scientists, reporting in the journal BMJ, say a class of high blood pressure drugs called angiotensin receptor blockers is associated with a striking decrease in the risk of occurrence and progression of dementia.

The researchers, using information from a U.S. Department of Health System Veterans Affairs database of more than 5 million people, examined records of more than 800,000 predominantly male patients 65 or older.

The researchers compared the patients in groups that included those using an angiotensin receptor blocker (ARB); those using an ACE inhibitor called lisinopril (Prinivil, Zestril); and those using other blood pressure/heart disease medications (excluding statins).

Angiotensin receptor blockers include candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan).

There were no differences in average blood pressure among the three groups.

The patients taking an angiotensin receptor blocker had a 19% lower risk of developing dementia compared to those taking lisinopril and a 24% lower risk compared to use of other blood pressure/heart medications. People taking both an ACE inhibitor and an angiotensin receptor blocker, which both target the angiotensin system, had a 46% lower risk of dementia compared with those taking other medications.

The researchers also studied records of patients who already were suffering from dementia or Alzheimer’s. Those patients taking ARBs, the scientists report, had a lower risk of being admitted to a nursing home or dying. Those taking both an ARB and an ACE inhibitor had a 67% lower chance of being admitted to a nursing home.

The results suggest that ARBs might protect against developing Alzheimer’s disease and dementia, the researchers write.

“For those who already have dementia, use of ARBs might delay deterioration of brain function and help keep patients out of nursing homes,” says Benjamin Wolozin, MD, PhD, professor of pharmacology at Boston University and one of the study researchers. “The study is particularly interesting because we compared the effects of ARBs to other medications used for treating blood pressure or cardiovascular disease.”

The researchers write that they do not know exactly why ARBs might be so beneficial, but they believe the drugs may help prevent and reduce nerve cell injury from stroke or blood vessel damage.

The researchers say they’ve conducted the first large-scale study to investigate whether angiotensin receptor blockers reduce the risk of developing Alzheimer’s or dementia.

The findings of the study are “immense,” write Colleen J. Maxwell, PhD, and David B. Hogan, MD, of the University of Calgary in an accompanying editorial. “About 36 million people worldwide have a form of dementia such as Alzheimer’s disease,” they write. “If survival, prevention or treatment do not improve dramatically, this number could double over the next 20 years.”

However, they add, though the findings of the study are dramatic, further work is needed to verify the results.

‘Longevity’ Gene May Cut Dementia Risk

By Denise Mann
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 12, 2010 — The so-called “longevity gene” may do more than add years to your life. It may also help stave off age-related cognitive decline, and this discovery is paving the way for new drugs to treat Alzheimer’s disease, a study shows.

The longevity gene is a variant of the cholesteryl ester transfer protein (CETP) gene, which was discovered in 2003. This variant has been shown to improve cholesterol levels by increasing HDL “good” cholesterol and regulating the size of cholesterol particles. As a result, it has been linked to longevity and lower heart disease risk, but how or if this variant affects the cognitive decline that is known to occur with aging was not known — until now.

The study is published in the Jan. 13 issue of the Journal of the American Medical Association.

Researchers analyzed the blood of 523 people aged 70 and older with no signs of cognitive decline to see which copy or copies of the CETP gene they carried. People in the study also underwent standard neuropsychological and neurological testing each year from 1994 to 2009 and performed tests to measure memory, attention span, and the time it takes to process and react to a signal (psychomotor speed).

During 4.3 years of follow-up, there were 40 new cases of dementia seen among this group. Those participants who had a specific variation of the CETP gene were less likely to experience a decline in memory and to develop dementia.

“We found that people with two copies of the longevity variant of CETP had slower memory decline and a lower risk for developing dementia and Alzheimer’s disease,” says study researcher Amy E. Sanders, MD, assistant professor in the Saul R. Korey Department of Neurology at the Albert Einstein College of Medicine in the Bronx, N.Y., in a news release.

“More specifically,” she says, “those participants who carried two copies of the favorable CETP variant had a 70 percent reduction in their risk for developing Alzheimer’s disease compared with participants who carried no copies of this gene variant.”

This variant alters the gene so that the protein it encodes for will functions less efficiently than usual, the researchers explain. Now, drugs are now being developed that mimic this effect.

“These agents should be tested for their ability to promote successful aging and prevent Alzheimer’s disease,” says study researcher Richard B. Lipton, MD, the Lotti and Bernard Benson Faculty Scholar in Alzheimer’s Disease and professor and vice chairman in the Saul R. Korey Department of Neurology at Albert Einstein College of Medicine, in a news release.

Frequent Mental Lapses May Precede Alzheimer’s

By Steven Reinberg
HealthDay Reporter
Latest Alzheimers News

* Mental Lapses May Precede Alzheimer’s
* ‘Longevity’ Gene May Cut Dementia Risk
* Hypertension Drugs May Cut Alzheimer’s Risk
* Alzheimer’s Could Be Signaled by Loss of Smell
* Nutrient ‘Cocktail’ Appears to Improve Dementia
* Want More News? Sign Up for MedicineNet Newsletters!

MONDAY, Jan. 18 (HealthDay News) — Mental lapses among older adults occur more often among those developing Alzheimer’s disease than healthy elders, new research finds.

Excessive daytime sleepiness, staring into space and disorganized or illogical thinking are other mental fluctuations that often precede Alzheimer’s, say researchers from Washington University School of Medicine in St. Louis.

“For many years, people have jokingly attributed mental lapses, or incidents when the train of thought temporarily seems to jump its tracks, as ‘senior moments,’” said lead researcher Dr. James Galvin, an associate professor of neurology. “It has never been clear as to whether these lapses could lead to the development of Alzheimer’s disease.

“We demonstrate clearly, for the first time, that such episodes are more likely to occur in persons who are developing Alzheimer’s disease,” he said.

But this doesn’t mean that everyone who has a “senior moment” is on the verge of dementia, Galvin stressed.

“While these lapses or fluctuations don’t by themselves mean that you have Alzheimer’s disease, our results suggest that they are something your doctor needs to consider if he or she is evaluating you for problems with thinking and memory,” he said.

The study is published in the Jan. 19 issue of Neurology.

For the study, Galvin’s team collected data on 511 seniors, average age 78, with memory problems. The researchers tested these adults with standard thinking and memory tests and also interviewed family members about their relative’s daytime sleepiness, disorganized or illogical thinking, or episodes of staring into space for long periods. Three or four symptoms were seen in 12% of participants, indicating cognitive fluctuations.

People with those symptoms were 4.6 times more likely to be diagnosed with Alzheimer’s and to have more severe Alzheimer’s symptoms, Galvin’s group found. They also performed worse on thinking and memory tests than people without these lapses.

Among 216 people diagnosed with very mild or mild dementia, 25 had mental lapses, while only two of the 295 without dementia had the fluctuations.

These mental lapses are common in a type of dementia called dementia with Lewy bodies — the second most common cause of dementia after Alzheimer’s disease, Galvin said. “But until recently we really did not know how frequently they occurred in people with Alzheimer’s disease or what effect fluctuations might have on their thinking abilities,” he said.

Cognitive fluctuations occur in Alzheimer’s disease and can significantly affect clinical rating of the severity of dementia and performance on memory and thinking tests. Assessing these fluctuations should be considered in evaluating patients for cognitive disorders, Galvin said.

Experts had mixed views on the significance of the findings.

“It is commonly observed that some Alzheimer’s disease patients can go through stages where they have apparent episodes of lucidity, when they can perform at much higher levels on ‘good days,’” said Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System.

This suggests that the cellular and molecular machinery required for higher performance has not been entirely lost but is frequently suboptimal, he said. “I find this quite hopeful as it suggests therapeutics might evoke more of these good days or moments,” said Cole, who is also associate director of the Alzheimer’s Disease Research Center at the University of California Los Angeles David Geffen School of Medicine.

But another expert said the finding adds nothing new to the diagnosis of Alzheimer’s disease.

Once many of these fluctuations start happening, “you are well on your way to dementia,” said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City.

The hope for improving the diagnosis and treatment of Alzheimer’s hinges on finding physical markers that indicate disease progression and the effectiveness of treatment, another expert said.

“The finding is a terrific ad for the need for biomarkers in Alzheimer’s disease,” said William Thies, vice president for medical and scientific affairs at the Alzheimer’s Association.

These mental fluctuations may be common, but are not an exact measurement of whether Alzheimer’s disease is present or how far it has progressed, he said.

“We would like something better, something that has more precision, less variation,” Thies said.