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Cheap, Older Gout Drug Could Be a Lifesaver After Heart Attack

By Dennis Thompson
HealthDay Reporter

SUNDAY, Nov. 17, 2019 (HealthDay News) — A cheap drug that’s been around for centuries as a gout treatment might also shield heart attack survivors from future heart crises, new trial results show.

The drug, colchicine, is derived from a plant called the autumn crocus, researchers explained Saturday at the annual meeting of the American Heart Association, in Philadelphia.

In the new trial, colchicine reduced by as much as 34% a heart attack survivor’s combined risk of either dying from heart disease or having cardiac arrest, a heart attack, a stroke or angioplasty.

Experts described the study as a “landmark” effort.

“These results provide confirmation that inflammation management reduces cardiovascular risk, and it was an example of a successful repurposing of a broadly available and relatively safe generic drug for a new application,” said Dr. Aruna Pradhan, a preventive medicine doctor at Brigham and Women’s Hospital in Boston.

Colchicine currently is used to treat gout and pericarditis (inflammation of the heart’s lining), two conditions caused by inflammation, said lead researcher Dr. Jean-Claude Tardif, director of research at the Montreal Heart Institute.

“You just give a few tablets of colchicine and the pain, the warmth, the redness, all the inflammatory signs go away,” Tardif said.

Tardif and his colleagues reasoned that colchicine might be able to reduce the risk of future heart problems by lowering inflammation in heart attack patients.

The trial involved more than 4,700 heart patients, with about half given daily low-dose colchicine taken by mouth and the rest provided a placebo. Nearly all patients also received the drug regimen normally prescribed to heart attack survivors — aspirin, blood thinners, statins and/or beta blockers.

Three years later, results showed that people on colchicine fared significantly better than those taking a placebo.

Besides the 34% reduction in all adverse heart events, the trial also found that patients taking colchichine had a 74% reduction in stroke risk, and a 50% reduction in their likelihood of being rushed to hospital for angioplasty/stenting after suffering chest pain.

The drug also appears to be safe. The most concerning side effect appears to be an increased risk of pneumonia, which affected about 1% of colchicine patients. Pradhan said pneumonia risk might be affected by the drug’s effect on inflammation.

Continued

Tardif said his research team is proceeding with a second trial focusing on heart risk among patients with type 2 diabetes.

Based on these findings, heart doctors will be thinking long and hard about adding colchicine to the drug cocktail prescribed to heart attack patients, said Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine.

“When you have a safe drug that is easily available, it’s going to be hard to hold this back,” Lloyd-Jones said.

The trial was funded by the provincial government of Quebec and received no drug company funding. However, colchicine’s new promise already appears to be affecting its sticker price, even though it’s a generic drug, Lloyd-Jones added.

He said that he recently saw a patient with gout on Thursday who complained that his colchicine prescription costs had unexpectedly skyrocketed.

“He told me that just in the last month, his colchicine out-of-pocket costs went from $ 50 to $ 270 a month in Chicago,” Lloyd-Jones said. “I really wonder whether there’s some gaming going on here, and I do not want to see that.”

Tardif expressed shock, given colchicine’s low cost in Canada.

“There’s something wrong with a system where 90 minutes away you get a drug for 50 times less what others are paying,” Tardif said, referring to what his patients pay in Montreal, an hour-and-a-half flight away.

The results were also published Saturday in the New England Journal of Medicine.

WebMD News from HealthDay

Sources

SOURCES: Aruna Pradhan, M.D., MPH, preventive medicine doctor, Brigham and Women’s Hospital, Boston; Jean-Claude Tardif, M.D., director, research,  Montreal Heart Institute; Donald Lloyd-Jones, M.D., ScM, chair, preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Nov. 16, 2019,New England Journal of Medicine, Nov. 16, 2019, presentation, American Heart Association annual meeting, Philadelphia

Copyright © 2013-2018 HealthDay. All rights reserved.

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Cheap, Older Gout Drug, Colchicine, Could Be a Lifesaver After Heart Attack

SUNDAY, Nov. 17, 2019 — A cheap drug that’s been around for centuries as a gout treatment might also shield heart attack survivors from future heart crises, new trial results show.

The drug, colchicine, is derived from a plant called the autumn crocus, researchers explained Saturday at the annual meeting of the American Heart Association, in Philadelphia.

In the new trial, colchicine reduced by as much as 34% a heart attack survivor’s combined risk of either dying from heart disease or having cardiac arrest, a heart attack, a stroke or angioplasty.

Experts described the study as a “landmark” effort.

“These results provide confirmation that inflammation management reduces cardiovascular risk, and it was an example of a successful repurposing of a broadly available and relatively safe generic drug for a new application,” said Dr. Aruna Pradhan, a preventive medicine doctor at Brigham and Women’s Hospital in Boston.

Colchicine currently is used to treat gout and pericarditis (inflammation of the heart’s lining), two conditions caused by inflammation, said lead researcher Dr. Jean-Claude Tardif, director of research at the Montreal Heart Institute.

“You just give a few tablets of colchicine and the pain, the warmth, the redness, all the inflammatory signs go away,” Tardif said.

Tardif and his colleagues reasoned that colchicine might be able to reduce the risk of future heart problems by lowering inflammation in heart attack patients.

The trial involved more than 4,700 heart patients, with about half given daily low-dose colchicine taken by mouth and the rest provided a placebo. Nearly all patients also received the drug regimen normally prescribed to heart attack survivors — aspirin, blood thinners, statins and/or beta blockers.

Three years later, results showed that people on colchicine fared significantly better than those taking a placebo.

Besides the 34% reduction in all adverse heart events, the trial also found that patients taking colchichine had a 74% reduction in stroke risk, and a 50% reduction in their likelihood of being rushed to hospital for angioplasty/stenting after suffering chest pain.

The drug also appears to be safe. The most concerning side effect appears to be an increased risk of pneumonia, which affected about 1% of colchicine patients. Pradhan said pneumonia risk might be affected by the drug’s effect on inflammation.

Tardif said his research team is proceeding with a second trial focusing on heart risk among patients with type 2 diabetes.

Based on these findings, heart doctors will be thinking long and hard about adding colchicine to the drug cocktail prescribed to heart attack patients, said Dr. Donald Lloyd-Jones, chair of preventive medicine at Northwestern University Feinberg School of Medicine.

“When you have a safe drug that is easily available, it’s going to be hard to hold this back,” Lloyd-Jones said.

The trial was funded by the provincial government of Quebec and received no drug company funding. However, colchicine’s new promise already appears to be affecting its sticker price, even though it’s a generic drug, Lloyd-Jones added.

He said that he recently saw a patient with gout on Thursday who complained that his colchicine prescription costs had unexpectedly skyrocketed.

“He told me that just in the last month, his colchicine out-of-pocket costs went from $ 50 to $ 270 a month in Chicago,” Lloyd-Jones said. “I really wonder whether there’s some gaming going on here, and I do not want to see that.”

Tardif expressed shock, given colchicine’s low cost in Canada.

“There’s something wrong with a system where 90 minutes away you get a drug for 50 times less what others are paying,” Tardif said, referring to what his patients pay in Montreal, an hour-and-a-half flight away.

The results were also published Saturday in the New England Journal of Medicine.

More information

The Mayo Clinic has more about colchicine.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Staying Slim After Weight-Loss Surgery Could Cut Cancer Risk in Half

WEDNESDAY, Nov. 6, 2019 — The drastic weight loss that occurs with successful bariatric surgery could have an extra benefit — it may slash your risk of cancer.

People with severe obesity who dropped more than 20% of their total body weight following surgery wound up cutting their risk of cancer by more than half, compared with those who didn’t lose as much weight after the procedure, a new study reports.

“Those who lost more weight had a significantly reduced risk of cancer,” said lead researcher Dr. Angela Stroud, an assistant professor with the Oregon Health & Science University School of Medicine’s division of bariatric surgery.

Previous studies have linked obesity to cancer, so these researchers set out to see exactly how much weight loss might protect a person.

Stroud and her colleagues turned to a long-term study of bariatric surgery, gathering data on more than 2,100 people treated at 10 medical centers across the United States. The type of surgery could either be gastric bypass or gastric banding.

People who underwent the surgery and didn’t lose weight had an overall higher risk of cancer during seven years of follow-up. Those whose body mass index (BMI) dropped under 30, the threshold for obesity, had a 40% reduced risk of cancer compared with those who remained obese.

Further, researchers found that the more weight a person lost, the less likely they were to develop cancer.

About 6.2% of those who lost less than 20% of their body weight received a cancer diagnosis within seven years of their surgery, compared with 3.6% of patients who lost 20% or more, researchers reported.

Those who lost between 20% and 35% of their total weight following bariatric surgery had a 56% reduction in their overall cancer risk, compared with those who lost less than 20% of their initial weight.

The results indicate that people who want to lower their cancer risk should opt for gastric bypass surgery, since the average person who underwent gastric banding did not lose anywhere near as much weight, Stroud said.

This also shows that obese people who are worried about cancer likely need weight-loss surgery to reduce their risk, said Dr. Eric DeMaria, president of the American Society for Metabolic and Bariatric Surgery. Diet and exercise likely can’t lead to the sort of dramatic weight loss that’s required.

“Here we have a study that says you’ve got to be more aggressive with the weight loss to really see the impact, and that really puts it in the terrain of bariatric surgery,” said DeMaria, chief of general and bariatric surgery at the East Carolina University Brody School of Medicine in Greenville, N.C. He wasn’t involved with the study.

Breast cancer was the most common among the patients, followed by thyroid, melanoma, colon, kidney, uterine and lung.

Dramatic weight loss might be reducing cancer risk by lowering rates of type 2 diabetes, Stroud said.

“There’s definitely an association between type 2 diabetes and cancer, so if we’re making diabetes better that might be one of the bigger players in all of this,” she said.

People who lose more weight also might be benefitting from much lower levels of inflammation, as well as healthier gut bacteria, Stroud said.

But researchers also found that metabolic changes directly linked to weight and appetite were associated with lower cancer risk.

For example, for each 20% reduction in leptin — a hormone that decreases hunger — there was a 20% reduction in cancer, researchers said.

Decreases in diabetes-related fasting glucose and insulin also were associated with reduced cancer risk, as were increases in ghrelin, the “hunger hormone.”

Studies like this shine a light on an underappreciated risk associated with obesity, compared with the risk of heart disease or diabetes, DeMaria said.

The link between obesity and cancer “is not widely appreciated among the public, I think,” DeMaria said. “People don’t intuitively say you’re at high risk for cancer if you’re obese. They don’t think that way. It’s not as known. “

The new study was presented Tuesday at the American Society for Metabolic and Bariatric Surgery’s annual meeting, in Las Vegas. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more about obesity and cancer.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

Drugs.com – Daily MedNews

Mom With Breast Cancer Has Healthy Baby After Chemo

Nov. 4, 2019 — Jade Devis was just a few months pregnant when she learned she had a fast-growing type of breast cancer. Her OB-GYN™s outlook was grim, she says: œMy baby was too young to save, and it was life-and-death for me.”

œWithin an hour of leaving the office and her telling me that, I was crying in the car, parked somewhere,” Devis says.

But today, after getting a lumpectomy and months of chemotherapy during her pregnancy, this 36-year-old bookkeeper in California is a happy first-time mom to Bradley, a 3-month-old boy. œWe™re doing really good right now,” she says.

photo of mom and newborn

She™s still getting chemo, with her final infusion scheduled for the end of November. Then she™ll get radiation therapy for a month. These treatments, along with surgery, are the main therapies for triple-negative breast cancer (TNBC), the disease Devis is battling.

œHoping for the best “ [a] cure!!” says her oncologist, Gayathri Nagaraj, MD, of Loma Linda University Cancer Center in California.

TNBC is an aggressive type of breast cancer that™s more common among women under 40, like Devis. It™s called triple negative because it isn™t fueled by the hormones estrogen or progesterone, or by a protein called HER2. That means hormone therapy and HER2-targeted drugs that treat other types of breast cancer don™t work for TNBC, which leaves those who have it with fewer treatment options.

Devis says she suspected something was wrong before her doctor diagnosed her with cancer. In January, just weeks into her pregnancy, she noticed a hard, painful lump above her left breast. The area felt like it was burning. She says her doctor at the time told her it was probably a clogged milk duct. But Devis was skeptical, and she kept voicing her concerns until she got a biopsy. It showed that she had cancer.

œI don™t think anybody understood my symptoms,” she says.

Triple-negative breast cancer can have the same signs as other types of breast cancer, and a new lump or mass is the most common red flag. Other symptoms of breast cancer are breast swelling, dimpling, or a nipple turning inward. Since there are a lot of warning signs, it™s important to have your doctor check any changes you notice.

After Devis got surgery to remove her cancerous lump and 10 nearby lymph nodes — operations that are generally safe for pregnant women — she went to the Loma Linda University Cancer Center in May to get the first of several rounds of chemotherapy.

œI was very upset because I thought I™d gone through so much already with the surgery, and my body was already bruised and injured and tired, and I was 6 months pregnant,” she says.

While chemotherapy isn™t safe for an unborn baby during the first 3 months of pregnancy, certain chemo drugs seem safe during months 4 through 9, the American Cancer Society says. Research shows that they don™t raise the chances of birth defects, stillbirths, or health problems soon after birth, though they could make an early delivery more likely. Also, researchers aren™t sure if chemo drugs could affect a baby™s health later in life.

In Devis™s case, her oncologist, Nagaraj, took safety measures to protect her and her baby. Nagaraj and her team made sure all the medications they gave Devis — including the chemo and meds to treat its side effects — were safe for her. They also carefully planned when they™d start and stop her chemo so they could pause it a safe number of weeks before Devis was scheduled to be induced. In general, the American Cancer Society says that getting chemo after 35 weeks of pregnancy or within 3 weeks of delivery is risky because it can lead to complications like bleeding or an infection during childbirth.

Devis also had a whole team caring for her. Nagaraj says maternal-fetal medicine specialists kept close tabs on the baby™s health. Pharmacists double-checked the safety of all her medicines. A dietitian gave her nutrition advice. Social workers provided psychological support through counseling. Nurses helped coordinate her care.

photo of woman receiving chemo

Even though the baby™s father wasn™t there for Devis, she got support from her mother and sisters, who did things like cook meals and go to the market for her. That was important to Devis, œbecause at the time I was hiding,” she says. She™d lost her hair during chemo and œdidn™t want to walk around, go out pregnant and bald — a lot of insecurities there.”

Uncertainty plagued her during treatment. Would the baby be OK? Would the chemo harm him? œI didn™t have a nursery yet set up because I wasn™t sure what the outcome was going to be,” she says. œAnd I was refusing baby gifts from everybody because I didn™t want to come home and have to return all these baby gifts in the worst-case scenario.”

œThe whole time I felt like I was being punished. I would sit in my room like I was in a jail cell, just waiting for the verdict,” she says.

Her worst fears didn™t come true. In late July, she gave birth to a healthy son. œWhen the baby was born, and I heard crying, and the NICU cleared him, it was like the verdict was in,” she says. œIt™s like that ˜we made it™ feeling, you know? ˜We™re here, we did it.™”

photo of baby birth announcement

Sources

SOURCES:

Jade Devis, Rancho Cucamonga, CA.

Gayathri Nagaraj, MD, oncologist, Loma Linda University Cancer Center, Loma Linda, CA.

CDC: œTriple-Negative Breast Cancer.”

American Cancer Society: œTreating Breast Cancer During Pregnancy,” œTreatment of Triple-negative Breast Cancer,” œTriple-negative Breast Cancer.”

Breastcancer.org: œTriple-Negative Breast Cancer.”

Up to Date: œER/PR negative, HER2-negative (triple-negative) breast cancer.”

National Breast Cancer Foundation: œTriple Negative Breast Cancer.”

Johns Hopkins Medicine: œTriple Negative Breast Cancer.”

National Cancer Institute: œNCI Dictionary of Cancer Terms.”

© 2019 WebMD, LLC. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });
WebMD Health

Consumers’ Orders Changed Slightly After Calorie Counts Added to Menus

THURSDAY, Oct. 31, 2019 — Calorie labels in fast-food restaurants appear to help customer trim purchases, but only up to a point, a new study says.

Customers ate slightly fewer calories after a fast-food chain started including calories on its menus, but the impact weakened over time, researchers found.

“Our findings suggest that calorie labeling may be most effective as a short-term strategy for reducing calorie purchases, but that other nutrition interventions may be necessary for long-term positive dietary changes in these settings,” said study lead author Joshua Petimar. He’s a research fellow at the Harvard Pilgrim Health Care Institute and Harvard Medical School.

In May 2018, calorie labeling on menus became mandatory for chains with 20 or more outlets in the United States. The goal was to help customers make healthier food choices.

However, effectiveness of this approach is unclear. Some studies have found associations between calorie labeling and calorie consumption, but most have been too small to identify differences before and after the introduction of calorie labeling on menus.

This new study is one of the largest to examine the issue, according to the researchers.

They assessed the impact of calorie labeling on food purchases by analyzing three years of sales data from a franchise of fast-food restaurants in the southern United States.

The franchise began providing calorie information on its menus in 2017. The researchers examined data from 2015-2018, ending up with information on nearly 50 million sales in the two years before and one year after the introduction of calorie labeling.

There was an initial decrease of 60 calories per sale (about 4%) after calorie labeling began, but that was followed by a slight weekly increase over the next year, according to the study.

“We recommend future research to estimate the effects of calorie labeling over a longer period, particularly once restaurants have had time to reformulate their menus,” Petimar said in an institute news release.

The study results are in the Nov. 2 issue of the BMJ.

More information

The U.S. National Library of Medicine outlines 10 ways to cut 500 calories a day.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

CDC: Youth Pot Use Dropped in States After Legalization, Including Colorado

According to a recently published study from the Centers for Disease Control and Prevention, youth marijuana use decreased in the nation’s first three states to legalize recreational pot.

The CDC study, released October 4, reports that marijuana use among children in sixth to tenth grade residing in King County, Washington — the state’s most populated county and home to the Seattle metro area — actually dropped from 2012 to 2016. Further, the CDC study reported that youth marijuana use in Colorado and Oregon followed the same trend. All three states legalized recreational marijuana sales by 2015.

Two possible reasons cited by the CDC for the decline or absence of youth marijuana use were the possibility of the plant losing its novelty appeal, as well as the reduction of the illicit market in states with regulated sales.

However, it’s important to note that the study’s authors say that legalization’s effects “might be delayed,” and that the time frame of the study didn’t occur during “the more recent surge in e-cigarette use by youth and the use of tetrahydrocannabinol (THC) within electronic cigarette (e-cigarette) devices.”

Marijuana Deals Near You

Dr. Ashley Brooks-Russell serves as project director for the Healthy Kids Colorado Survey, a bi-annual study from the state Department of Public Health and Environment that monitors youth drug use. According to Brooks-Russell, there isn’t a clear explanation as to why Colorado hasn’t seen a rise in youth marijuana use since retail pot was legalized. However, she does believe that more protective parenting with regard to marijuana and drug use has increased.

“We’re in an age of protective parenting, where adolescence is being extended into adulthood,” she says. “It’s being protected longer, and parents are learning to become more aware of their kids’ activities.”

The CDPHE has been trying to push Colorado parents toward a more engaging role in their kids’ social lives and potential peer pressures, according to CDPHE marijuana communications specialist Tara Dunn, who says kids who feel like they can talk to their parents or another trusted adult about substance use are less likely to use marijuana.

“Parents play an important role in preventing youth marijuana use,” she says. “Educating kids about marijuana early and keeping that conversation going is really important.”

And that conversation doesn’t really end as kids grow up. Kids are always changing interests and friend groups, Dunn adds, so it’s important for parents to be aware of social and stress factors in their kids’ lives, and continue maintaining an engaged role.

Brooks-Russell also advocates for “parental monitoring,” and says parents should always work to improve communication with their kids. Setting clear family expectations and knowing a child’s friend circle helps parents stay aware of what environment their kids are in outside of the house, she says.

“Parents need to have a conversation and make it clear what their expectations are,” she says. “It’s important to help their kids avoid situations that might cause drug use, such as not knowing who their kids hang out with or leaving their kids home alone.”

According to a 2018 survey from Healthy Kids Colorado, kids who know their parents disapprove of underage marijuana use are 72 percent less likely to start using, while kids who have other trusted adults they can talk to about their problems are 30 percent less likely to try marijuana. School performance can also be a factor in youth marijuana use, according to to the survey, as 28 percent of students who receive affirmation for their work are less likely to use marijuana.

“Kids who don’t feel connected or feel good in school may affiliate with other teens who use drugs,” Brooks-Russell explains. “And drug use is affiliated with poor school performance.”

For parents who may not be sure about how to talk to their kids about marijuana, Colorado has several statewide campaigns that teach both parents and kids about the effects of marijuana use. The CDPHE currently funds five community organizations that serve eleven counties to teach adults about youth marijuana use, while websites such as responsibilitygrowshere.com can be online sources for parents to learn more about youth marijuana use.

“Educating yourself is important,” Dunn says. “It helps you, and also helps your kids in the long run.”


Toke of the Town

Ask a Stoner: Waiting to Drive After Smoking Pot

Dear Stoner: How many hours after smoking marijuana does it take for you to be able to drive?
Dewayne

Dear Dewayne: This isn’t an answer we can just pull out of our butt cracks for you. There isn’t enough science to sit on in order to give you an exact time frame, but our asses aren’t completely bare, either. Because cannabis impairment isn’t as easy to determine through breath and blood levels, law enforcement still doesn’t have an exact way of determining how high you really are, though advancements are being made in breath and blood testing to detect THC levels and determine when a driver last consumed.

A Colorado county sheriff measures a driver's impairment levels during a 2018 driving experiment that measures the skills of alcohol and cannabis users.

A Colorado county sheriff measures a driver’s impairment levels during a 2018 driving experiment that measures the skills of alcohol and cannabis users.

Thomas Mitchell

Most state laws surrounding cannabis DUIs focus on the amount of THC in the blood, measuring it in nanograms (Colorado’s limit is 5 nanograms). However, daily users are likely to have high levels of THC even if they last smoked the day before, while novice and new users will have low levels of THC in their blood several hours after consumption, despite still being baked.

It all comes down to your tolerance and the potency of the cannabis. Still, we’d recommend waiting at least a couple hours after you toke before you think about driving, no matter what.

Send questions to marijuana@westword.com.


Toke of the Town

How Safe is Vaginal Delivery After a Cesarean Birth?

FRIDAY, Sept. 27, 2019 — Once a woman gives birth by cesarean section, attempting a vaginal delivery is far riskier for mother and baby alike, a new study finds.

Researchers at the University of Oxford collected data on more than 70,000 births in Scotland between 2002 and 2015. Among women who attempted a vaginal delivery after a previous C-section, 28% had to have an emergency cesarean, they reported.

Attempting vaginal delivery was associated with an added risk of uterine rupture, blood transfusion, body-wide infection and injury from surgery.

The risks for the infant included stillbirth, admission to a neonatal unit and resuscitation using drugs or intubation.

For mothers, the absolute risk of any of these complications, however, was low — 2% in those attempting a vaginal birth and 1% of those having a C-section.

Babies suffered one or more complications in 8% of attempted vaginal births and 6% of subsequent C-sections, the study found.

Kathryn Fitzpatrick, an epidemiologist at Oxford’s Nuffield Department of Population Health, led the study, which was published online Sept. 24 in the journal PLOS Medicine.

“Our findings can be used to counsel and manage women with previous cesarean section and should be considered alongside existing evidence on the increased risk of serious maternal morbidity in subsequent pregnancies associated with elective repeat cesarean section,” she said in journal news release.

More information

To learn more C-section deliveries, visit the American College of Obstetricians and Gynecologists.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

HRT Could Benefit Younger Women After Hysterectomy

By Serena Gordon
HealthDay Reporter

MONDAY, Sept. 9, 2019 (HealthDay News) — Estrogen therapy may help younger women live longer after having their uterus and ovaries surgically removed, new research reports.

The study found that when women under 60 received hormone replacement therapy (HRT) after surgery, their risk of dying during the 18-year follow-up period decreased by almost one-third compared to women taking a placebo.

“In a young woman, it’s generally better to conserve the ovaries, because early removal of the ovaries induces early surgical menopause and increases the risk of cardiovascular disease, fractures and osteoporosis. But if the ovaries are removed, and a woman is under 60, estrogen therapy gives them a more favorable risk profile,” said study lead author Dr. JoAnn Manson. She’s chief of the division of preventive medicine at Brigham and Women’s Hospital in Boston.

About 425,000 women have a hysterectomy (uterus removal) every year in the United States. Between a third and a half also have their ovaries removed. This is done to reduce their risk of ovarian cancer, according to the researchers.

Removing the ovaries is also known to reduce breast cancer risk. But when they are removed in younger women (around 45 to 50), the procedure is linked to a higher risk of heart disease and death from any cause, the researchers noted.

“Women who have had their ovaries removed have an abrupt decline in their estrogen levels, more so than women with intact ovaries,” Manson explained.

Researchers had a hunch that replacing that lost estrogen might reduce the risk of heart disease and early death.

To see if that was the case, they recruited about 10,000 women who had a hysterectomy. They were between 50 and 79 years old. Just over 4,000 also had both ovaries removed.

The women were randomly assigned to receive either estrogen or a placebo for about seven years. Their health was followed for 18 years.

Women in their 50s who had their ovaries removed had a 32% lower risk of dying during the study if they took estrogen, the findings showed. Older women who had their ovaries removed and took estrogen didn’t have that same benefit.

Continued

Women who still had their ovaries didn’t seem to have any benefits or harms related to taking estrogen, the study found.

Dr. Meera Garcia, division chief of obstetrics and gynecology at New York-Presbyterian Hudson Valley Hospital in Cortlandt Manor, N.Y., reviewed the study and welcomed the findings. “This study provides a great support and evidence to what’s going on in clinical practice,” she said.

“Everything has benefits and side effects, and with hormones, we’re coming more to the middle now,” Garcia added. “There’s a right time and a right place for medication, and when we’re continuing what the body has been doing [by replacing estrogen in younger women] — it seems to provide benefits.”

Both Manson and Garcia said there’s no absolute cut-off age for hormone therapy.

“The duration of estrogen therapy is an individual decision. Is a woman continuing to have hot flashes? What is her risk for breast cancer? What about cardiovascular disease risk? Or a risk of osteoporosis? All of these factors come into play when making the decision,” Manson explained.

Garcia said when women decide it’s time to come off of hormone therapy, it’s helpful to slowly lower the dosage over time.

The findings were published Sept. 9 in the Annals of Internal Medicine.

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Sources

SOURCES: JoAnn Manson, M.D., chief, division of preventive medicine, Brigham and Women’s Hospital, and professor of medicine, Harvard Medical School, Boston; Meera Garcia, M.D., division chief, obstetrics and gynecology, New York-Presbyterian Hudson Valley Hospital, Cortlandt Manor, N.Y.;Annals of Internal Medicine, Sept. 9, 2019

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Czech doctors deliver baby girl 117 days after mother’s brain-death

BRNO (Reuters) – When a helicopter rushed an unconscious Czech woman who had suffered a severe stroke to hospital in April, her chances of survival were slim – and those of the fetus she had carried in her womb for 15 weeks little better.

And yet, on Aug. 15, against all odds, a healthy baby girl was born by cesarean section – weighing 2.13 kg (4.7 lb) and measuring 42 cm (16.5 inches) – to her brain-dead mother, setting a new record in the process, Brno’s University Hospital said on Monday.

It said the 117 days that she had been kept alive in the womb – a process fraught with potential complications – were believed to be a record for the longest artificially sustained pregnancy in a brain-dead mother.

The mother, whose identity was not revealed, had been declared brain-dead shortly after reaching the hospital, upon which doctors immediately began the struggle to save her child.

They put the 27-year-old woman on artificial life support to keep the pregnancy going, and even regularly moved her legs to simulate walking to help the child’s growth.

After the delivery in the 34th week of gestation, with the husband and other family members present, medical staff disconnected the mother’s life support systems and allowed her to die.

“This has really been an extraordinary case when the whole family stood together … without their support and their interest it would never have finished this way,” Pavel Ventruba, head of gynecology and obstetrics at the hospital, told reporters.

(This story was refiled to correct doctor’s surname in last paragraph)

Reporting by Jiri Skacel; Writing by Robert Muller; Editing by Kevin Liffey

Reuters: Oddly Enough

After Heart Attack, Stenting More Than the Blocked Artery May Be Best

SUNDAY, Sept. 1, 2019 — Opening all of a person’s clogged arteries after a heart attack can protect their health better than reopening only the one that caused it, a major international clinical trial has concluded.

Opening all blockages and not just the “culprit” behind the attack reduces a patient’s risk of dying or having another heart attack by 26%, researchers reported Sept. 1 in the New England Journal of Medicine.

This large-scale trial confirms nearly a decade’s worth of research pointing in the same direction, and should lead to this approach becoming standard practice, said lead researcher Dr. Shamir Mehta. He’s director of interventional cardiology at Hamilton Health Sciences in Hamilton, Ontario.

“The results were very clear. They weren’t borderline,” he said. “It will almost certainly have an impact on the guidelines and on clinical practice, not just in the U.S. or Canada, but worldwide.”

About half of all heart attack victims have more clogged arteries than the one that caused their heart attack, the researchers said in background notes.

Of those patients with multiple blockages, at least 80% should be able to benefit from having all of their clogged arteries reopened, said Dr. Samin Sharma, director of clinical and interventional cardiology at Mount Sinai Hospital, in New York City.

Importantly, having the additional blockages reopened did not increase a patient’s risk of other health problems, Sharma noted.

Mehta said, “This study shows that if you do it correctly, nothing happens. The kidney injuries were identical. The vascular complications were identical. There was no increase in stroke. This approach appears to be a home run in a large number of cases.”

Heart attacks happen because a single clogged artery prevents the flow of blood to the heart, damaging the organ.

Initial treatment focuses on reopening that artery and restoring the flow of oxygen to the heart muscle, Mehta said.

But there has been great debate about what to do about other blocked arteries that a patient might have.

“That’s where all the controversy has been,” Mehta said. “Should we just leave them alone? Have they been there for years, and are they not going to cause any problems in the future? Should we really run the risk of going back in and opening them just after a patient’s had a major heart attack?”

The guidelines were “really on the fence about this issue,” Mehta said. “The data wasn’t there to say 100% go ahead and fix them or don’t fix them. It was kind of in the middle.”

At least eight years of studies and clinical trials have provided mounting evidence that reopening all of the blockages should improve a person’s outcome, said Dr. C. Michael Valentine, president of the American College of Cardiology.

“This is the long-awaited confirmation that most cardiologists have been waiting for,” said Valentine, a senior cardiologist at Stroobants Cardiovascular Center of Centra Health in Lynchburg, Va.

To provide this definitive answer, the researchers undertook a clinical trial involving more than 4,000 patients treated at 140 hospitals in 31 countries.

All patients had their blocked “culprit” vessel reopened, Mehta said.

After that initial procedure, about half were randomly chosen for a second procedure days later to reopen the rest of their blocked arteries.

Taking care of the other blockages cut in half a person’s combined risk of either death from heart disease, a repeat heart attack, or a need to return and have another clogged artery reopened due to chest pain or other symptoms, the findings showed.

Over a median of three years, about 8% of patients who had everything reopened suffered a second heart attack or cardiovascular death. That compared to about 11% of those who received treatment only for the artery that caused the first heart attack.

“We’ve shown clearly that putting stents in these clogged arteries and opening them provides a major benefit,” Mehta said. “The interesting thing is that the benefit accrues over the long term. The trial followed patients for up to three years, and the benefit continued to accrue over that period.”

Mehta and Sharma expect fully opening all blockages also would save money over the long run, compared with people returning to the hospital with future problems caused by untreated clogged arteries.

“You can’t really send a patient with a full-blown heart attack home anyway. You have to keep them in hospital for 48 hours, at minimum,” Mehta said. “They’re sitting around anyway in the hospital. To bring them down the next day and fix the other blockages is not that huge an increase in cost.”

However, the results also show there’s no rush. Patients benefitted from having all blockages reopened even if the follow-up procedure took place weeks later, Mehta said.

“The nice thing about the trial is if a person is frail or elderly, or if they have kidney disease, it’s OK to delay it and let the patient recover from the initial heart attack,” he said. “Then when they’re strong enough, you can bring them back and do the other vessels.”

It’s important for physicians to understand there are options, he said. “You don’t have to do it right away.”

Still, Sharma suggested, it might be even more cost-effective to clear all the blockages during the initial procedure.

“If you know it’s a simple blockage, why do you need to wait until the next day? Why don’t you do it at the same time? That’s the only question that’s not answered by this study,” Sharma said.

The results of the clinical trial were also presented Sunday at the European Society of Cardiology’s annual meeting, in Paris.

More information

The American Heart Association has more on the warning signs of a heart attack.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

When Does Heart Health Return to Normal After Quitting Smoking?

TUESDAY, Aug. 20, 2019 — When you stop smoking, your heart starts to rebound right away, but a full recovery can take as long as 15 years, a new study suggests.

“The benefit of quitting smoking cannot be overstated — the cardiovascular system begins to recover quickly, with some physiologic changes happening within hours,” said lead researcher Meredith Duncan, of the division of cardiovascular medicine at Vanderbilt University Medical Center in Nashville, Tenn.

Duncan and her team found that within five years after quitting, your risk of heart disease is significantly lower than that of people who continue to puff away. But it takes 10 to 15 years before your risk is similar to that of someone who never smoked.

Experts have long thought that an ex-smoker’s risk of heart attack, stroke, heart failure or death from heart disease returns to normal within five years.

Given this new finding, Duncan said doctors should consider that heavy smokers who stop will have a higher-than-normal risk for heart problems for at least a decade.

“Full recovery may take several years, so today is a great day for current smokers to quit smoking, and make a doctor’s appointment to plan for successful long-term cessation and to discuss other steps toward heart health,” she said.

For the study, her team collected data on nearly 8,800 men and women who took part in the Framingham Heart Study, a long-term, ongoing study of factors that contribute to heart disease.

Among the study participants, nearly 2,400 were heavy tobacco users, meaning they smoked at least one pack of cigarettes a day for 20 years, or an equivalent.

During an average follow-up of 26 years, more than 2,400 participants had a heart attack, stroke, heart failure or died from heart disease. Of these, nearly 1,100 were heavy smokers, the researchers found.

Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles, said nearly every study of former smokers finds that their risk for heart events is lower than that of those who continue to smoke.

“It’s never too late, from a cardiovascular risk standpoint, to stop smoking,” he said, no matter how much you smoke or how long you’ve done so.

Fonarow pointed out that smoking is a leading cause of heart attacks, strokes, heart failure, peripheral vascular disease and premature death. “Quitting significantly lowers this risk,” he said.

But the length of time when the risk is reduced to the same level as people who never smoked has been estimated to be anywhere between two and 20 years, he said. It’s usually pegged at five years, he added. This new study among heavy smokers doubles that time.

“It is best to never start smoking,” Fonarow said. “For those who do smoke, it is important to completely quit as soon as possible.”

The report was published Aug. 20 in the Journal of the American Medical Association.

More information

To learn more about smoking and cardiovascular disease, head to the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

Drugs.com – Daily MedNews

Pot Poisonings Among Kids, Teens Double After Medical Marijuana Law Passed

FRIDAY, Aug. 16, 2019 — Pot-related poisoning calls involving kids and teens more than doubled in Massachusetts after the state legalized medical marijuana, a new study reports.

Calls related to cannabis exposure increased 140% in the years after Massachusetts voted to legalize medical pot in 2012, according to data from the state’s regional poison control center.

This happened even though Massachusetts learned from the example of other states and placed tough packaging requirements to make pot products less enticing and harder to open for kids, said lead researcher Jennifer Whitehill. She’s an assistant professor with the University of Massachusetts Amherst School of Public Health and Health Sciences.

“It was not the same as it was in Colorado, circa 2013, when there were products labeled to look like candy wrappers,” Whitehill said. “Nonetheless, even despite opaque and tamper-proof and child-proof packaging requirements, we still saw little kids getting into the products and having some bad experiences.”

The new report echoes previous studies showing an increase in marijuana-related medical problems following legalization in Colorado and Washington, the researchers noted.

For example, a March 2019 study in the Annals of Internal Medicine found that marijuana-related visits to emergency rooms more than tripled at one Colorado hospital between 2012 and 2016.

Based on that example, Massachusetts lawmakers adopted strict mandates for childproof packaging and warning labels on marijuana products, Whitehill said.

To see if those tougher requirements made any difference, Whitehill and her colleagues analyzed poison control center data from 2009 through 2016, four years before and after a ballot initiative legalized medical marijuana in the state.

During the study period, poison control received 218 calls from Massachusetts involving pot exposure in children and teens. The calls represented only 0.15% of all calls to poison control during that period related to kids.

But the incidence of pot-related calls leapt to 1.1 calls per 100,000 population after legalization, up from just 0.4 calls per 100,000 population prior to legalization, the findings showed.

“I had been hopeful that the stricter packaging laws that Massachusetts implemented would have prevented us from seeing some kind of increase,” Whitehill said.

Nearly four out of five calls came from health care facilities and involved exposures that resulted in moderate or minor health effects, the researchers said. There were only four cases with major effects, and no deaths were reported.

In one case, two teenage boys collapsed while playing sports hours after smoking what they thought was marijuana, the study says. The teens, 17 and 18, went into cardiac arrest but were successfully resuscitated.

About one-quarter of the cases were reported as unintentional ingestion, with nearly 20% of those involving children younger than 4.

The results provide parents a “good reminder to be thoughtful and cautious about where they store their cannabis, especially edible products,” Whitehill said.

Teens represented the largest number of cases reported to poison control, with ages 15 to 19 accounting for 82% of all calls related to marijuana.

Experimentation likely spurred most of those calls, Whitehill said.

“Teenagers are clever and crafty,” Whitehill said. “Parents for a long time have thought about where to store alcohol that isn’t easily accessible by their children. As the social norms around cannabis in people’s homes start to change, I think it’s well worth parents thinking about the safer storage of cannabis products.”

These results show that more can be done to keep legal pot out of the hands of children, said Linda Richter, director of policy research and analysis with the Center on Addiction, in New York City.

“Policymakers should ban marijuana edibles that look like regular food products — especially those that appeal to children, such as gummy bears, lollipops, other candy, chocolate or brownies,” Richter said. “In addition to child-resistant packaging, opaque and resealable packaging for marijuana edibles should be required to help prevent young children from being able to see or access the marijuana inside the package, even if it has already been opened.”

Manufacturers also should be required to package marijuana products in small doses so even if a child does get into a package, their exposure will be minimized, Richter said.

As far as teens are concerned, Richter urges parents to set a good example.

“What parents do is just as or more important than what they say to kids,” Richter said. “If they have a cavalier attitude about marijuana, extolling its benefits and conveying how much they need it to relax or have fun, that message comes across much more strongly to kids than any admonitions regarding its harms.”

The new study was published online Aug. 16 in JAMA Network Open.

More information

The Center on Addiction has more about discussing marijuana with your teen.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

Drugs.com – Daily MedNews