Check blood pressure at home, not MD's office: study


Think you need to go to the doctor's office to check your blood pressure? Think again: The best way to predict your risk of stroke or heart attack due to high blood pressure is through systematic monitoring at home rather than periodic checks in the doctor's office, new research suggests.
"With home blood pressure monitoring you get a greater number of measurements and there is no white-coat effect," lead author Dr. Teemu Niiranen told Reuters Health, speaking of the tendency for anxiety to drive up blood pressure. "At home the patient is more relaxed and this seems to provide blood pressure values that reflect the patient's true blood pressure better."
Writing in the American Heart Association's journal Hypertension, Niiranen and colleagues at Finland's National Institute of Health and Welfare concluded that home-measured blood pressure is a better predictor of heart disease-related problems than office-measured blood pressure.
High blood pressure is a major risk factor for heart disease, stroke, and kidney disease, and nearly one in three Americans have high blood pressure, according to the Centers for Disease Control. In 2006 it contributed to the deaths of 326,000 Americans.
The researchers used data on more than 2,000 Finns, 45 to 74 years old, gathered between 2000 and 2001. Participants agreed to be interviewed, undergo medical exams and monitor their blood pressure at home on well-calibrated monitoring devices.
At follow-up nearly 7 years later, 162 participants reported at least 1 non-fatal heart disease-related event such as a heart attack, stroke, or hospitalization due to heart failure. Among the 2,081 participants, 37 heart disease-related deaths were reported.
After analyzing the data, the Niiranen group concluded that the best predictor of heart attacks, strokes, and related deaths was home blood pressure monitoring.
The home blood pressure readings, because there were more of them and they weren't affected by the "white coat effect," were more accurate, the authors found.
The home blood pressure monitor used in the study - Omron's HEM-722c, comparable to the HEM-712c in the U.S. -- costs about $70. Niiranen said 60 percent of Finnish patients with high blood pressure have home monitors.
While the study was done in Finland, Niiranen said there's no reason to believe these results would not also apply to the populations in other countries.
The study could not determine whether home monitoring could save lives, however, since it was only observational, Niiranen said




Smoking Ups Risk of Second Breast Cancer


Breast cancer survivors who smoke are at increased risk for a second cancer, a new study shows.
Researchers followed women who were diagnosed with early-stage breast cancer and underwent breast-conserving therapy, which consists of a lumpectomy followed by radiation therapy.
Fifteen years after treatment, the overall risk of developing a new, second cancer was 25 percent in the 796 smokers and 19 percent in nonsmokers. The risk of developing cancer in the breast that hadn't been treated for cancer was 13 percent for smokers and 8 percent in nonsmokers.
"These new data are significant in that they show women can exercise some control over a known risk factor for developing a new second cancer," senior investigator Dr. Bruce G. Haffty, associate director of the Cancer Institute of New Jersey, said in a news release.
The study was to be presented at the annual meeting of the American Radium Society, May 1 to 5 in Cancun, Mexico.




For Younger Women, Mammograms Not Too Effective: Study


Mammograms in women under the age of 40 result in many return visits for follow-up screenings but don't turn up cancer very often, a new study finds.
Almost 30 percent of U.S. women between the ages of 30 and 40 report getting mammograms, although they're not generally recommended until age 40.
In the new study, Bonnie C. Yankaskas of the University of North Carolina at Chapel Hill and colleagues studied a database of 117,738 women who got their first mammogram between the ages of 18 and 39. The researchers followed the women for a year to see what happened to them.
The researchers found that screening mammograms -- not diagnostic mammograms, which try to resolve a specific problem -- among women aged 35 to 39 had poor accuracy and high rates of return visits for more screening.
The screening turned up an average of 1.6 cancers per 1,000 women, according to the report published online May 3 in the Journal of the National Cancer Institute.
For this age group, the researchers write that "our findings support a need for serious discussion about the appropriateness of mammography in women without the presence of symptoms."




Aspirin May Increase Risk of Crohn's Disease


A new British study finds that people who take aspirin every day have a higher risk of developing Crohn's disease, a potentially devastating digestive illness.
But it's still not very likely that aspirin users will develop the condition, and the study's lead author said patients should keep in mind that aspirin lowers the risk of heart disease.
"If the link with aspirin is a true one, then only a small proportion of those who take aspirin -- approximately one in 2,000 -- may be at risk," said study author Dr. Andrew Hart, a senior lecturer in gastroenterology at University of East Anglia School of Medicine. "If aspirin has been prescribed to people with Crohn's disease or with a family history by their physician, then they should continue to take it. Aspirin has many beneficial effects and should be continued."
An estimated 500,000 people in the United States have Crohn's disease, which causes digestive problems and can boost the risk of bowel cancer. In some cases, patients must undergo surgery; many have to take medications for the rest of their lives.
While aspirin is known for its ability to reduce the risk of heart disease, it can cause stomach ulcers, and research in animals has suggested it can be hard on the intestines, too. The study authors decided to see if it had the same effect in humans, Hart said.
In the new study, researchers tracked 200,000 volunteers, aged 30 to 74, from several European countries.
The researchers found that aspirin use for a year or more boosted the risk of Crohn's disease by five times.
However, the study only suggests there's a link between aspirin use and the disease; it doesn't prove that aspirin actually increased the risk. And the researchers didn't know how much aspirin each person took.
Why might aspirin boost the risk of Crohn's disease? Dr. William J. Sandborn, vice chair of Mayo Clinic's Division of Gastroenterology and Hepatology, said it might have something to do with aspirin damaging the lining of the bowel, potentially triggering the condition in those who are susceptible to it because of their genetic makeup.
Sandborn, who's familiar with the findings, agreed with Hart that patients need to think about the benefits of aspirin use, including the reduced risk of not only heart disease but also colorectal cancer.
The study found no link between aspirin use and ulcerative colitis, another digestive disorder.
Future research is needed to confirm the aspirin-Crohn's disease link and determine what aspirin has to do with the higher risk, Hart said.
"If it does turn out to be a true link in the future, then it will be only one of many factors involved in causing Crohn's disease," he said. "Because aspirin has benefits, users should continue with it."
The study was to be presented Monday at the Digestive Disease Week conference in New Orleans




Older Women With Diabetes Face Higher Risk For Colon Cancer


A research team led by Mayo Clinic physicians has found that older women with diabetes face a more than doubled risk for some types of colorectal cancer. The findings are being presented at Digestive Disease Week 2010, the annual meeting of the American Gastroenterological Association.

Colorectal cancer remains the third-leading cause of cancer deaths among women in the United States. Diabetes has been identified as a colon cancer risk factor, but the mechanisms aren't completely understood. For this population-based cohort study, researchers examined data from 37,695 participants of the Iowa Women's Health Study (IWHS), which enrolled women ages 55-69 in 1986 and remains ongoing. Of these women, 2,361 reported a diagnosis of Type 2 diabetes and 1,200 developed colorectal cancer.

To find the links between colorectal cancer and diabetes, the researchers worked with regional pathology laboratories to obtain tumor tissue samples from IWHS participants who were diagnosed with colorectal cancer. They linked the tissue samples with other IWHS data, looking for cancer pathways and risk factors, and whether those risk factors were associated with three different molecular markers: microsatellite instability (MSI), CpG island methylation (CIMP), and BRAF gene mutations.

"Diabetes was more strongly associated with the MSI-high, CIMP-positive and BRAF-mutation cancer subtypes in this group of older women," says Mayo Clinic gastroenterologist Paul Limburg, M.D.. Dr. Limburg explains that diabetes appeared to confer a greater than twofold increase in risk for these molecularly-defined tumors, compared to women without diabetes.

"Knowing that diabetic women have these findings should help to facilitate more appropriate colorectal cancer prevention and treatment options," says Anthony Razzak, M.D., a Mayo Clinic research fellow and presenter at the conference. "Our findings may lead to new strategies for colon cancer screening, chemotherapy and chemoprevention in women with diabetes."

"From a research perspective, this information allows us to clarify how environmental exposures and other risk factors might effect tumor formation at a molecular level," says Dr. Razzak. For future projects, the researchers will work to understand more about the biology of colorectal cancer and how it is influenced by diabetes, as well as other chronic conditions and exposures. They hope to use that information to improve patient care.

"Unfortunately, diabetes and colon cancer are both very common in the United States, so making links between these disorders has substantial public health implications," says Dr. Limburg.




Broccoli Component Could Help Prevent Or Treat Breast Cancer

compound derived from broccoli could help prevent or treat breast cancer by targeting cancer stem cells -- the small number of cells that fuel a tumor's growth -- according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

The study tested sulforaphane, a component of broccoli and broccoli sprouts, in both mice and cell cultures. Researchers found sulforaphane targeted and killed the cancer stem cells and prevented new tumors from growing.

"Sulforaphane has been studied previously for its effects on cancer, but this study shows that its benefit is in inhibiting the breast cancer stem cells. This new insight suggests the potential of sulforaphane or broccoli extract to prevent or treat cancer by targeting the critical cancer stem cells," says study author Duxin Sun, Ph.D., associate professor of pharmaceutical sciences at the U-M College of Pharmacy and a researcher with the U-M Comprehensive Cancer Center.

Results of the study appear in the May 1 issue of Clinical Cancer Research.

Current chemotherapies do not work against cancer stem cells, which is why cancer recurs and spreads. Researchers believe that eliminating the cancer stem cells is key to controlling cancer.

In the current study, researchers took mice with breast cancer and injected varying concentrations of sulforaphane from the broccoli extract. Researchers then used several established methods to assess the number of cancer stem cells in the tumors. These measures showed a marked decrease in the cancer stem cell population after treatment with sulforaphane, with little effect on the normal cells. Further, cancer cells from mice treated with sulforaphane were unable to generate new tumors. The researchers then tested sulforaphane on human breast cancer cell cultures in the lab, finding similar decreases in the cancer stem cells.

"This research suggests a potential new treatment that could be combined with other compounds to target breast cancer stem cells. Developing treatments that effectively target the cancer stem cell population is essential for improving outcomes," says study author Max S. Wicha, M.D., Distinguished Professor of Oncology and director of the U-M Comprehensive Cancer Center.

The concentrations of sulforaphane used in the study were higher than what can be achieved by eating broccoli or broccoli sprouts. Prior research suggests the concentrations needed to impact cancer can be absorbed by the body from the broccoli extract, but side effects are not known. While the extract is available in capsule form as a supplement, concentrations are unregulated and will vary.

This work has not been tested in patients, and patients are not encouraged to add sulforaphane supplements to their diet at this time.

Researchers are currently developing a method to extract and preserve sulforaphane and will be developing a clinical trial to test sulforaphane as a prevention and treatment for breast cancer. No clinical trial is currently available



People With Common Heart Defect Also More Likely To Have Brain Aneurysms

A new study shows that people with a common heart defect may also be more likely to have brain aneurysms. The study is published in the May 4, 2010, print issue of Neurology, the medical journal of the American Academy of Neurology.

Up to two percent of the population is born with the heart defect called a bicuspid aortic valve (BAV). The aortic valve allows blood to flow from the heart to the aorta. It normally has three flaps that open and close to regulate blood flow. In people with a bicuspid aortic valve, the valve does not develop fully during gestation and there are two flaps instead of three.

Some people with BAV never have any problems, but many develop narrowing or leakage of the aortic valve, especially as adults.

Recent research has shown that the artery problems with BAV may also occur in the brain, and that BAV may be a connective tissue disorder. Brain aneurysms are a weakening in a brain artery that causes a bulge in the artery.

"Since brain aneurysms are a treatable problem that can lead to death and disability if they rupture, we wanted to find out how common they are in people with BAV," said study author Wouter Schievink, MD, Director of Microvascular Neurosurgery at Cedars-Sinai Medical Center in Los Angeles, Calif.

For the study, 61 people with BAV were screened for brain aneurysms, along with 291 people who did not have BAV but were undergoing scans for a suspected stroke or brain tumor during the same time period.

Six of the 61 people with BAV had brain aneurysms, or 9.8 percent, compared to three of the 291 people who did not have BAV, or 1.1 percent. Studies have shown that 0.5 to two percent of the general adult population has brain aneurysms.

"While more research needs to be done to confirm these results, these findings show a significant increased risk of brain aneurysms in people with bicuspid aortic valves," Schievink said.

Schievink said the heart defect has been shown to cluster in families, and screening is generally recommended for close family members of people diagnosed with bicuspid aortic valves.




Extremely Premature Infants Benefit From Probiotics

Extremely low birthweight infants (ELBW) who received feedings supplemented with probiotics had better weight gain than infants who were not given the supplements, according to a randomized, controlled, double-blind study presented at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Probiotics, which means "for life" in Latin, are healthy, live organism supplements that provide benefit to the host. Their effect on digestive health and immune function has been studied. However, the safety and efficacy of probiotic supplementation in ELBW infants has not been explored thoroughly.

In this study, Mohamad Al-Hosni, MD, and colleagues from three medical centers, in collaboration with Vermont Oxford Network, evaluated the effect of supplementing enteral (tube) feedings with probiotics in extremely premature infants who weighed 2 pounds, 2 ounces or less. They hypothesized that infants who received probiotic-supplemented feedings would tolerate larger volumes of feeding per day, grow faster and require fewer days of antimicrobial treatment than those in the control group.

Fifty infants received 500 million colony-forming units (CFU) of Lactobacillus rhamnosus GG and 500 million CFU of Bifidobacterium infantis in enteral feedings once a day until discharge or 34 weeks postmenstrual age. Fifty-one infants received feedings with no probiotics.

Results showed superior weight gain in infants who received the probiotics even though the average daily volume of their feedings was less than infants in the control group. There were no statistically significant differences in other complications of prematurity such as sepsis or necrotizing enterocolitis. In addition, no side effects were seen as a result of probiotic supplementation, according to Dr. Al-Hosni, an assistant professor of pediatrics at Saint Louis University School of Medicine in the division of neonatal-perinatal medicine at SSM Cardinal Glennon Children's Medical Center.

"These findings strongly suggest that probiotic supplementation to enteral feedings plays a major role in feeding tolerance and nutrient absorption," he said. "Improved tolerance of feedings and nutrient absorption lead to better weight gain in this extremely premature infant group."

Dr. Al-Hosni concluded that larger clinical trials are needed to demonstrate the safety and efficacy of probiotic supplementation to enteral feeding in this group of infants