Posted by on October 29, 2010 - 1:05pm

In the largest human study to date on the topic, researchers have uncovered evidence of the possible influence of human sex hormones on the structure and function of the right ventricle (RV) of the heart.

The researchers found that in women receiving hormone therapy, higher estrogen levels were associated with higher RV ejection fraction (ejection refers to the amount of blood pumped out during a contraction; fraction refers to the residue left in the ventricle after the contraction)  with each heart beat and lower RV end-systolic volume — both measures of the RV’s blood-pumping efficiency — but not in women who were not on hormone therapy, nor in men. Conversely, higher testosterone levels were associated with greater RV mass and larger volumes in men, but not in women, and DHEA, an androgen which improves survival in animal models of pulmonary hypertension, was associated with greater RV mass and volumes in women, similar to the findings with testosterone in men.

“This study highlights how little is known about the effects of sex hormones on RV function. It is critical from both research and clinical standpoints to begin to answer these questions,” said Steven Kawut, M.D., M.S.,  director of the Pulmonary Vascular Disease Program at the University of Pennsylvania School of Medicine in Philadelphia.

The study was published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

Study participants were part of The MESA-Right Ventricle Study (or MESA-RV), an extension of the Multi-Ethnic Study of Atherosclerosis (MESA), a large, NHLBI-supported cohort focused on finding early signs of heart, lung and blood diseases before symptoms appear. Using blood samples and magnetic resonance imaging (MRI) of the heart, researchers measured sex hormones and RV structure and function in 1957 men and 1738 post-menopausal women. Because the MESA population is ethnically mixed and covers a broad age range of apparently healthy people, the results may be widely applicable to the general U.S. population.

“One of the most interesting things about this research is that we are focusing on individuals without clinical cardiovascular disease so that we may learn about determinants of RV morphology before there is frank RV dysfunction, which is an end-stage complication of many heart and lung diseases,” said Dr. Kawut. “When we study people who already have RV failure from long-standing conditions, the horse has already left the barn. We are trying to assess markers that could one day help us identify and intervene in individuals at risk for RV dysfunction before they get really sick.”

Because the RV plays a critical role in supplying blood to the lungs and the rest of the body, RV function is closely tied to clinical outcomes in many diseases where both the heart and lungs are involved, such as pulmonary hypertension, COPD and congestive heart failure. However, the RV is more difficult to study and image than the left ventricle and comparatively little is known about its structure and function and how to treat or prevent right heart failure.

Corey E. Ventetuolo, M.D., lead author of the study from  Columbia University College of Physicians and Surgeons, reported,  “Our results have generated some interesting questions about RV response to the hormonal milieu. For example, the finding that higher levels of testosterone (and DHEA) were associated with greater RV mass would first appear to have adverse clinical consequences, since increasing cardiac mass is traditionally thought to be maladaptive. However, another study from MESA-RV has shown that higher levels of physical activity are also linked to greater RV mass, which would suggest an adaptive effect. So, whether the increased RV mass seen with higher hormone levels is helpful or harmful is not yet clear. The sex-specific nature of the associations we found was unexpected and reflect the complexity of the actions of sex hormones.”

Sex hormone levels could help explain a key paradox in pulmonary arterial hypertension (PAH), where the RV response is an important determinant of survival.  While women are far more likely to develop PAH, they also have better RV function and may have a better survival than men. “It is possible that hormone balance could predispose them to developing PAH, but confer a protective benefit in terms of RV adaptation,” explained Dr. Kawut.

The ultimate goal would be strategies to treat or prevent RV failure in those at high risk.

Source:   American Thoracic Society

Posted by on October 26, 2010 - 9:29am

When does the U.S. Health Care Law take effect?

Several provisions of the new health care law have already gone into effect and more take effect each year through 2014 and beyond. January 1, 2011 is the next key date when more provisions take effect.

Kaiser Family Foundation’s new interactive Implementation Timeline allows you to see by year, when provisions take effect and allows you to filter your selection by topic area (such as financing/taxes or Medicare).  View the timeline at

Posted by on October 25, 2010 - 11:49am

Researchers at the University of Texas Southwestern Medical Center report that estrogen therapy after menopause increases a woman's chances of developing kidney stones.  Kidney stones are common among postmenopausal women, affecting between 5% and 7% of the population in the U.S.  Up until now, only observational studies have been done looking at kidney stones and estrogen, and the results have been conflicting.   This study shows new evidence based on a randomized, placebo-controlled trial.

Lead study author, Dr. Naim Maalouf and colleagues conducted trials at 40 U.S. clinical centers where a total 10,739 post-menopausal women with hysterectomies and 16,608 post-menopausal women without hysterectomies were randomized to receive either an estrogen supplement or a placebo. Among those receiving hormones, 335 cases of kidney stones were reported versus 284 cases in the placebo groups.  In general, kidney stones are less common among pre-menopausal women than among men in the same age group, but the disparity lessens after menopause, suggesting that estrogen may have a protective effect.

However, study lead author Maalouf points out the study challenges the belief estrogen may protect against kidney stones.   "This research suggests that the opposite might be true, and it offers new information that might be considered when prescribing estrogen-replacement therapies to post-menopausal women," Maalouf says in a statement.

The study did not detect any link between kidney stone risk and body mass index, age, prior hormone therapy, coffee usage, diuretic usage, or ethnicity.

The exact mechanisms for these findings are yet to be determined.

Source:   Archives of Internal Medicine, October 11, 2010.

Posted by on October 22, 2010 - 9:22am

We all have friends who are brilliant (e.g, can give you the dates of every World War, can explain nanotechnology, can transpose music instantly, etc), but when it comes to health issues, they don't know what the difference is between an allergy and the flu.  Nearly all of us have some problems with health literacy.

Health literacy is not only about reading.  It's about understanding difficult health terms and conditions.   For example, health literacy plays a role in how well:

  • Someone knows to take the right medicine at the right time (Is it two pills once a day or is it one pill two times a day!).
  • A person with diabetes properly manages the condition (How many of us understand the glucose cycle in the body?).
  • A parent follows instructions for helping a child recover from surgery (You just want to hug them!).
  • You are able to sort out what bills cover the hospital, the doctors, and the office visits!

Limited literacy can literally harm your health.   The Agency for Healthcare Research and Quality (AHRQ), has developed a to help doctors and their staff improve communications with all patients, especially those who do not speak the local language, have ongoing mental and physical ailments that may affect their judgment and ability to listen, and someone who has just learned they have a deadly disease.

In addition, Carolyn Clancy, MD, director of AHRQ, recently provided a list of activities individuals can do to improve literacy.   They are:

  • Ask questions.   She suggests you prepare a list of questions prior to your appoint and her agency provides a sample LIST.
  • Repeat information back to your doctor or nurse.  Do not hesitate to say, "Let me see if I understand this...."
  • Bring all your medicines to your next visit.   Go over the instructions on the labels and make sure there are no drugs that negatively  interact, especially with over the counter meds that you may take without your doctor's knowledge.
  • Bring a friend.
  • If you don't speak the same language as your doctor, ask to have a translator available.
  • Make a Pill card.   Directions are available HERE.
Posted by on October 20, 2010 - 9:10am

On October 15, 2010, the U.S. Food and Drug Administration approved Botox injection (onabotulinumtoxinA) to prevent headaches in adult patients with chronic migraine. Chronic migraine is defined as having a history of migraine and experiencing a headache on most days of the month.   it is estimated that about 6% of men and 18% of women suffer from migraine headaches during any given year.

“Chronic migraine is one of the most disabling forms of headache,” said Russell Katz, M.D., director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “Patients with chronic migraine experience a headache more than 14 days of the month. This condition can greatly affect family, work, and social life, so it is important to have a variety of effective treatment options available.”

Migraine headaches are described as an intense pulsing or throbbing pain in one area of the head. The headaches are often accompanied by nausea, vomiting, and sensitivity to light and sound. Migraine is three times more common in women than in men. Migraine usually begins with intermittent headache attacks 14 days or fewer each month (episodic migraine), but some patients go on to develop the more disabling chronic migraine.

To treat chronic migraines, Botox is given approximately every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms. Botox has not been shown to work for the treatment of migraine headaches that occur 14 days or less per month, or for other forms of headache. It is important that patients discuss with their physician whether Botox is appropriate for them.

The most common adverse reactions reported by patients being treated for chronic migraine were neck pain and headache (NOTE from this blogger:   FDA should define what kind of headache---treat migraine headaches with a medicine that may cause headaches???).

OnabotulinumtoxinA, marketed as Botox and Botox Cosmetic, has a boxed warning that says the effects of the botulinum toxin may spread from the area of injection to other areas of the body, causing symptoms similar to those of botulism. Those symptoms include swallowing and breathing difficulties that can be life-threatening. There has not been a confirmed serious case of spread of toxin effect when Botox has been used at the recommended dose to treat chronic migraine, severe underarm sweating, blepharospasm, or strabismus, or when Botox Cosmetic has been used at the recommended dose to improve frown lines.

Posted by on October 18, 2010 - 3:47pm

Aspirin therapy to prevent heart attack may have different benefits and harms in men and women.

Cardiovascular disease (CVD) is the leading cause of death in the U.S., contributing to approximately 58% of deaths.  The epidemiology of CVD events is different for men and women.   Men have a higher risk for coronary heart disease and tend to have these events at a younger age than women.

Although incidence rates of stroke are higher among men than women, more women die of stroke than men because of their longer life expectancy.

Back in 2002, the US Preventive Services Task Force (USPSTF) strongly recommended that clinicians discuss aspirin with adults who are at increased risk for coronary heart disease. This preventive measure was based on 5 randomized controlled trials that showed a 28% reduction in myocardial infarctions (heart attack) with aspirin use.   Only 2 of 5 studies included women!   At that time it was not clear if the earlier recommendation base on mainly male dominated studies was valid for women. In 2005, the large Women's Health Initiative (WHI) provided some new data about the benefits of aspirin in women but confusion continued.

In March 2009, the U.S. Preventive Services Task Force reviewed new evidence from NIH's Women's Health Study and other recent research and found good evidence that aspirin decreases first heart attacks in men and first strokes in women. The Task Force has issued a recommendation that women between the ages of 55 and 70 should use aspirin to reduce their risk for ischemic stroke (lack of blood and oxygen due to a clot or other disease process) when the benefits outweigh the harms for potential gastrointestinal bleeding.

In summary, as of March 2009, the USPSTF recommends:

  • The use of aspirin for men age 45-79 years when the potential benefit due to reduction in myocardial infarctions outweigh the potential harm due to an in increase in GI bleeding.
  • The use of aspirin for women age 55-79 when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in GI bleeding.
  • The current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.
  • Against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.

The new report does conclude that aspirin increases the risk for major bleeding events, primarily GI bleeding in both men and women.   There is also limited evidence that hemorrhagic strokes are significantly increased among men but not women.

As with other studies we have cited on this blog, recommendations are always subject to change as new research is completed.   It is wise to discuss your individual concerns with your physician because other health factors could influence your decisions.    The entire discussion above also reinforces the need for ALL research to look at sex and gender differences even in the most basic trials so that when we want to apply  findings to humans, we already know if there are sex differences --- as we are finding out about aspirin therapy.

The recommendation and other materials are available at Exit Disclaimer U.S. Preventive Services Task Force, Ann Intern Med 150(6):396-404, 2009 (AHRQ supports the Task Force). See also Optowsky, McWilliams, and Cannon, J Gen Intern Med 22:55-61, 2007 (AHRQ grant T32 HS00020).

Posted by on October 14, 2010 - 3:17pm

Breast Cancer is a major health concern for all women, including women with disabilities. About 30% of women aged 40 years or older have a disability.  In the US in 2008, 76.2% of women aged 40 or older reported having a mammogram in the past two years, while women with a disability have a lower reported mammography rate than women without a disability.  The Center for Disease Control and Prevention (CDC) has prepared a fact sheet that includes tips for women with disabilities to help them eliminate difficulties they may encounter while undergoing screening.    To view the CDC article, click HERE.

October is Breast Cancer Awareness Month----it's a good time for ALL women to be sure they have appropriate screenings.  For the men who read this blog, make sure the women in your lives take care of themselves and find time to be screened.  Remember, too, that about 1% of breast cancer cases  (nearly 2,000 per year) are found in men so if you have an unusual growth or swelling in the chest area, have it checked out!  They sometimes do mammograms on men, too!

Posted by on October 13, 2010 - 3:09pm

On March 11, 2010, this site posted a BLOG about news reports that raised the question about whether or not there is an increased risk of atypical subtrochanteric femur fractures in patients taking bisphosphonate medication for osteoporosis.  At that time, the data that the FDA reviewed did not show a clear connection between these rare fractures and these drugs but physicians patients were encouraged to be vigilant if using these drugs.

Today, October 13, 2010,  the Food and Drug Administration (FDA) issued a somewhat stronger warning that there is a possible increased risk of this rare thigh bone fracture in patients taking bisphosphonates.  FDA still says it is not clear whether bisphosphonates are the cause of the unusual bone breaks known as subtrochanteric femur fractures, which occur just below the hip joint,  and diaphyseal femur fractures, which occur in the long part of the thigh.   However, they are concerned enough to change the labeling  and the medication guides.

The FDA says the optimal duration of using these drugs to treat osteoporosis is unknown--an uncertainly the agency is highlighting because these fractures may be related to use of bisphosphonates for longer than five years.  They will continue to evaluate the effect of long-term treatment.   To view the updated FDA article, click HERE.

Posted by on October 12, 2010 - 10:46am

Free breast and cervical cancer screening is available in all 68 of the U.S. states, tribes and territories through a program that has been in existence for 20 years.  The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) sponsored by the Center for Disease Control and Prevention (CDC) provides access to free or low cost mammograms and Pap tests to under-insured and uninsured women.   To receive services through this program,  federal guidelines require a woman to be under-insured or uninsured.  Each state/territory has it's own definitions for these terms.    Women must  be between the ages of 40 and 64 for breast cancer screening.  Cervical cancer screening is also available through this program and there are some states that offer coverage for treatment if cancer is detected.    An estimated 8-11% of women throughout the US are eligible to receive services.   To find out if you qualify for free or low-cost mammograms and Pap tests, contact your local program by visiting or call 1-800-CDC-INFO.