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A Growing Heart Problem: Congestive Heart Failure
Tweet Share on Facebook February 3, 2009 Comment (12)By Bernadine Healy, M.D.
The good news about coronary artery disease is that fewer people are having—or dying from—heart attacks in the prime of life. And those who have heart attacks are likely to survive and live on into ripe old age. The challenge, however, is that many of these heart attack survivors are left with weakened hearts that, over time, quietly give out, creating a virtual epidemic of chronic congestive heart failure in the elderly. Heart failure now accounts for a million hospitalizations a year and carries a high mortality—and has replaced heart attacks as the lethal face of cardiovascular disease in most of the Western world.
This evolution from heart attack to heart failure was made stark by a study from Canada reported last month in the Journal of the American College of Cardiology that, for five years. monitored nearly 8,000 men and women over age 65 who had survived their first heart attack. Not only did three quarters of the study patients develop heart failure, but close to 40 percent of them died from it. The tricky thing about heart failure in this older population is that its symptoms of fatigue, shortness of breath, and even swollen ankles all too often are attributed to age rather than a lethal cardiac condition. And up to half of those who succumb to heart failure do so suddenly and unexpectedly.
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Estrogen Paradox: Can HRT Be Both Good and Bad for the Brain?
Tweet Share on Facebook January 15, 2009 Comment (29)By Bernadine Healy, M.D.
Estrogen is living up to its long-held reputation as the memory molecule. It gets soaked up by the brain and promotes nerve connections in all manner of species—from man to ape, rodent to songbird. But, paradoxically, it is also a molecule that can shrink an older women's brain, accelerating its demise into the dark night of Alzheimer's disease. In research from the Women's Health Initiative released this week, brain scans helped explain why some women show deterioration when given hormone replacement therapy (HRT) begun in their older years.
The two new MRI studies from the NIH and Wake Forest University found, surprisingly, that the primary problem is neurodegenerative—that is, the destruction of neurons—not indirect damage caused by ministrokes, as researchers had anticipated. They identified a small amount of brain shrinkage and loss of working tissue in the brain's memory center and in higher brain regions typical of what's seen in Alzheimer's.
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Teen Sex and Pregnancy: Part of a Bigger Problem
Tweet Share on Facebook January 9, 2009 Comment (74)By Bernadine Healy, M.D.
There is nothing worse for any physician than to find a dangerous medical problem in a patient and feel powerless to help. That's how the whole country seems to feel as it hears about gloomy statistics on teen pregnancy released this month from the Centers for Disease Control and Prevention. The findings show a 3 percent jump in teens having babies, following 14 years of decline. Many adults seem to have given up even trying to influence teen sexual behavior, and the statistics on teen sex have incited plenty of finger-pointing at sex-education programs as if they are the central solution to this very complex problem. This is the wrong reaction to what is a major public health issue.
Viewing this as a nonpartisan, nonideological, teen health issue—which also affects some 435,000 babies born into woefully disadvantaged circumstances—what emerges in all fairness is that the 3 percent jump between 2005 and 2006 (the most recent analyzed) in births among teens between 15 and 19 years of age equals the 3 percent increase in birthrates for all women. The year 2006 was an especially fertile one in America. And one good trend is that births among girls under 15 actually fell a bit. But, parents, heed this: The birthrate among all unmarried women rose an astounding 7 percent to almost 40 percent of all births—accounting for 1,641,946 little ones. Thus, out-of-wedlock births are a trend in society at large. In fact, the birthrate for all unmarried women has risen almost without interruption for 60 years. In the 1940s, when the first baby boomers were being born, it was closer to 4 percent.
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What Sanjay Gupta Offers a Daschle-Run Health Team
Tweet Share on Facebook January 8, 2009 Comment (44)Though Barack Obama has not spoken, it appears that his transition team has confirmed that Sanjay Gupta, the chief medical correspondent for CNN, is the president-elect's top choice to be U.S. surgeon general. Gupta, a surgeon and assistant professor of neurosurgery at Emory University (where he still cares for patients), would bring to the White House and the Department of Health and Human Services unique talents unrivaled by any of the prior 17 surgeons general going back to 1871. Among them are his truly outstanding health communication skills and the fact that he is already a trusted figure in many people's living rooms on all matters of health and disease—particularly on the major national heath problems that are within the domain of the surgeon general.
Gupta's leadership of CNN's "Fit Nation," a broad initiative targeting obesity (including the hazards of obesity in children), for example, meshes well with a similar initiative forged by former Surgeon General David Satcher, who back in 2002 called for the nation to recognize obesity as both a disease and a national epidemic that requires communities—not just individuals—to take action. Gupta's extensive reporting on AIDS readies him to take on that epidemic with the same vigor C. Everett Koop displayed. Gupta is similarly ready for tobacco, which has been a major focus of most surgeons general since Luther Terry. In 1964, Surgeon General Terry initiated the long, drawn-out war against the evil weed with the most famous and enduring of the many surgeon general's reports that connect tobacco use to lung cancer and other diseases.
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8 Traits of Teens Who Abstain From Sex
Tweet Share on Facebook January 7, 2009 Comment (109)Speaking as a physician, I have no doubt that teens need to be thoroughly educated about sex: why and how to avoid it when it's of no benefit to their physical or emotional well-being (virtually always) and how to maximally protect themselves if they do get sexually involved (all too often).
At a public-health level, there is no such thing as virginity-only teaching—if only because it doesn't serve close to half of all teens, who are already sexually active. Actually, it's a wonder it's not more. We live in an anything-goes society in which Sex and the City has become a cultural icon, half of 18-year-olds using social network sites like MySpace clutter them with the joy of risky behaviors that include sex and drug abuse, and grown-ups seem to be more worried about what the kids are divulging than what they are doing.
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Mothers Are Key to Preventive Health
Tweet Share on Facebook January 2, 2009 Comment (9)Prevention is not working. Despite a flood of health information, U.S. surgeons generals' reports, and the Healthy People 2010 health promotion and disease prevention agenda laid out by the federal government, we are still falling short. It's not that most people don't know their diet is awful or their waistline is bulging or they're having risky sex. It's that they don't take it to heart.
As dedicated as public-health efforts have been in making prevention a national goal, it's fair to say that making it happen needs a major boost. What's missing, I think, is an all-out effort to mobilize moms. Mothers—not doctors or public-health experts—are the nexus of prevention. However weighty a burden this may seem, Mom is the figure everywhere in the world best positioned to influence the behavior of those she loves, and that's the influence we need to reverse the dismal trend in America's health status.
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7 Factors That Foster Teen Virginity, Pledge or No Pledge
Tweet Share on Facebook December 30, 2008 Comment (79)Pledges of no sex until marriage don't work, especially if taken by 15- or 16-year-olds, according to a recent study in the journal Pediatrics. Despite broken promises, however, virginity-pledging teens were considerably more conservative in their overall sexual behaviors than teens in general—a fact that many media reports have missed cold. In other words, the act of making a virginity pledge doesn't appear to affect a teen's future sexual behavior. But the kind of teen who takes a pledge is the kind who's already likely to be sexually restrained throughout adolescence.
There's an important message here for parents: The focus should be on cultivating the teenager's ongoing home and social environment, rather than on eliciting a one-time, easily-forgotten promise.
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8 Hours of Sleep: a Heart-Healthy Goal for 2009
Tweet Share on Facebook December 24, 2008 Comment (14)Who would have thought that how we sleep would turn out to be a coronary artery risk factor every bit as important as smoking or high blood pressure? But that's how it is shaping up. The recent study in the Journal of the American Medical Association is making the sleep-heart connection impossible to ignore: In short, as hours of sleep drop toward five or fewer from the eight hours most humans seem to need, the chance of developing coronary disease in young middle-aged men and women grows in close proportion. The JAMA study used a relatively new low-dose CT scanning technique to detect calcium buildup in arteries long before patients have the slightest inkling any plaque is there.
Accelerating hardening of the arteries in those skimping on sleep is consistent with many prior observations. For example, people afflicted with chronic loud snoring, a sleep disrupter known particularly to men, experience more heart attacks and higher blood pressure than those who sleep like a baby. And a 10-year study involving thousands of middle-aged women found that those who slept for five or fewer hours a night had a greater chance of suffering heart attacks than similar women who managed a good eight hours of sleep. (Prudence in all things: Getting too much sleep wasn't the best either—with those exceeding nine hours bumping up their heart risk.)
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Men: Even a Little Extra Weight Hurts the Heart
Tweet Share on Facebook December 23, 2008 Comment (3)The 21,091 smart, healthy men who joined the Harvard-based Physicians' Health Study with no evidence of coronary disease over 20 years ago are now proving by their own good or bad behavior the value of the advice they have been giving to their patients for years about the effect of weight, exercise, and diet on the heart.
In a just released report in the journal Circulation, even modestly increased weight was associated with an increase in heart failure resulting from heart attacks, diabetes, or high blood pressure. In this group, which now averages 53 years of age, for every pound added on, the risk of heart trouble grew, so that obese physicians faced a sobering 180 percent increase in their chance of heart failure compared with their leaner colleagues.
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Weight-Loss Potions Have Hidden Surprises
Tweet Share on Facebook December 23, 2008 Comment (2)The Food and Drug Administration is not the Grinch who stole Christmas for warning just before the holiday that a passel of weight loss drugs—28 to be exact, all currently available over the counter or on the Internet—can be dangerous to people's health. In fact, the agency may be a health savior for lots of people who have been lulled into taking diet potions that might work but bear surprise ingredients, two of which are particularly concerning.
Most of these products contain some level of sibutramine, the active agent in the FDA-approved and controlled weight-loss drug Meridia. Meridia is prescribed (along with a sensible diet) for morbid obesity (a BMI greater than 30) or for those who are overweight and also have complications like diabetes. Sibutramine works on the brain to decrease the yearning for more food while eating by altering some key neurotransmitters like serotonin, norepinephrine, and dopamine. But messing with these brain chemicals can bring other effects, including elevation of blood pressure in a group of patients already prone to hypertension.
