For Elderly, Invasive Heart Procedures May Beat Drugs
Physicians often choose to treat heart disease in the elderly with drugs rather than invasive procedures, such as angioplasties and bypasses, on the theory that the old are more likely to suffer severe side effects from surgery.
But Dr. Matthias Pfisterer and his colleagues from University Hospital in Basel, Switzerland, found that the benefits might far outweigh the risks.
They studied 305 people, ages 75 and older, with chronic angina, chest pain caused by a constriction in the arteries feeding the heart. The patients were randomly assigned to receive either the best drug therapy or an invasive procedure such as angioplasty or bypass, collectively known as revascularization.
The team reported in Saturday’s Lancet that, after six months, the severity of the angina decreased and the quality of life improved in both groups, although the improvements were greater in patients who underwent invasive procedures.
Furthermore, there were major adverse cardiac events in 49% of the patients who received only drugs, compared with 19% of those who underwent revascularization.
Few Treatments for Chronic Fatigue Disorder
Behavioral therapy may provide some benefit for patients with chronic fatigue syndrome, but overall there are few effective treatments for the mysterious disorder, according to a new survey.
The syndrome affects as many as 800,000 Americans, primarily women, Latinos and African Americans.
Many physicians still adhere to the once common belief that it is a psychological problem rather than a physical one, but the consensus now is that it is a physiological problem with definite physical causes--even though it is not yet known what those causes may be.
Dr. Penny Whiting of the University of York in England and her colleagues surveyed 44 studies on CFS treatment dating from 1986 to the present. They reported in Wednesday’s Journal of the American Medical Assn. that cognitive behavioral therapy--counseling in coping strategies such as stress management--and a program of increasing exercise showed the most promising results.
The treatments produced only modest improvements, however. Drugs were even less effective, they concluded.
Childhood Sunburns Raise Risk of Skin Cancer
Childhood sunburn increases the risk of adult skin cancer, according to new research in mice. The sunburn apparently causes DNA damage that can lie dormant for decades before erupting as tumors long after the original insult is forgotten.
The findings provide experimental support for epidemiological studies that have indicated the same thing.
Molecular geneticist Glenn Merlino of the National Cancer Institute and his colleagues studied mice that are genetically engineered to produce human-like skin and tumors. They reported in Thursday’s issue of Nature that young mice exposed to high doses of ultraviolet light--the most damaging form of sunlight--developed melanoma as adults.
Melanoma is the most deadly form of skin cancer.
Although it accounts for less than 10% of all cases of skin cancer, it is responsible for nearly all deaths from the disease.
Elderly Are Dying of Disease, Not ‘Old Age’
The elderly rarely die of “old age,” according to a new study. Instead, they die of specific diseases, just like their younger counterparts.
Researchers at Auckland University School of Medicine in New Zealand studied forensic autopsy reports on 319 people who were older than 90 when they died. Only 5% of the deaths were “written off” as being due to old age, the team reported in American Journal of Forensic Medicine and Pathology.
About 85% of the deaths were due to natural causes: heart disease, pneumonia, complications from bone fractures and stroke, primarily. Nearly all the unnatural deaths were due to accidents--usually falls--but there were also three suicides and one homicide.
“There is a common conception that the very old die of old age,” the researchers wrote. But, they concluded, “the elderly die of disease, not old age.”
Researchers Find Gene Linked to Lupus
Colorado researchers working with mice have identified the first gene linked to systemic lupus erythematosus, also known as SLE or simply lupus.
Lupus is an autoimmune disease affecting one in every 1,000 people in the United States, 90% of them women. Its name is derived from the characteristic skin rash, but it also attacks internal organs and can be deadly.
Treatment involves the use of steroids and other immunosuppressive drugs.
Working with New Zealand mice that show disease features virtually identical to lupus in humans, Dr. Brian Kotzin and his colleagues at the University of Colorado Health Sciences Center reported in this month’s Immunity that they found that lupus was linked to a gene called Ifi202.
But they cautioned that it is just one of many genes that cause the disorder. Understanding what causes the disease may lead to new treatments.
Diet-Exercise Combo Is’Best of Both Worlds’
Low-fat diets that are high in carbohydrates lower levels of harmful cholesterol, but they can raise levels of other blood fats linked to heart disease. A new study, however, suggests that accompanying the diet with moderate exercise can block some of the potentially harmful effects of the diet.
Low-fat, high-carbohydrate diets reduce the risk of heart disease by lowering levels of LDL cholesterol, the so-called bad cholesterol. But they also raise the level of triglycerides, which are thought to increase the risk of heart disease, and lower levels of HDL cholesterol, the so-called good cholesterol.
Dr. Adrianne E. Hardman and her colleagues at Loughborough University in Leicestershire, England, however, reported in the October issue of Arteriosclerosis, Thrombosis and Vascular Biology that daily moderate exercise--brisk walking for an hour each day--negated the adverse effects of the diet on triglycerides. It did not, however, reverse the decrease in good cholesterol.
Nonetheless, Hardman concluded, this diet-and-exercise combo “may be the best of both worlds for coronary heart disease risk.”
*
Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
