Oral Contraceptives...Associated with Increased Diagnoses of Systemic Lupus Erythematosus

A recent article published in the Journal of Arthritis Care and Research found that women who were currently taking oral contraceptives or had just started taking the pill, particularly if the dosage of estrogen was that seen in older formulations, had a higher prevalence of being diagnosed with systemic lupus. The researcher from Magill University in Montreal, Canada reported that in women with a particular genetic predisposition, a higher dose of estrogen in first and some second generation birth control pills may trigger the onset of symptoms associated with systemic lupus. This effect was not seen in women who were using lower dose formulations utilizing less than 50 micrograms of estrogen. There has been a belief that there may be a hormonal effect that is causal in the development of systemic lupus erythematosus. Because lupus is diagnosed in a ratio of 9:1 in women versus men, it is believed that there may be a hormonal mechanism that turns on a heightened immune response leading to the symptoms of lupus in genetically susceptible individuals. The authors also suggested a dose related effect, in that as the estrogen content of the pill increased, the diagnoses of lupus increased in the population of women studied.
The authors looked at the records of a UK registry following the health of more than 1.7 million women ages 18 to 45 over an eight year period who were using combined estrogen and progesterone containing oral contraceptives. They found 786 women diagnosed with lupus during the study period. Smoking, drinking and other autoimmune disorders such as type 1 diabetes and thyroiditis were diagnosed more frequently. All current users of birth control pills were at an increased risk of developing lupus but the increase was not statistically significant. There appears to be an estrogen mediated effect on the lymphocytes and this may explain the dose-related response in which increased doses of estrogen are associated with an increased prevalence of lupus. One reassuring fact was that previous users of birth control pills did not exhibit an increased incidence of lupus.
The take home message is that women should talk with their healthcare providers about using a low-dose estrogen pill when using an oral contraceptive. The other point to remember is to alert your doctor of a family history of lupus or any other autoimmune condition in your family when having your yearly check-up so that he/she has the opportunity to take that into consideration when prescribing not only birth control pills but any medication. The more information the healthcare provider has about you, the chance of making an good informed decision about your healthcare management is increased. Read more.

Obesity...Think Carefully About Having That Piece of Cake.

We have been hearing about the adverse effects of obesity and the ever growing numbers of people who are entering the ranks of the seriously overweight. But now we have a well designed study published yesterday in the Lancet from a researcher in Oxford, England showing that people who fall into the category of being over the normal range of BMI (body mass index) which is 22.5 to 25, have a 30% increased risk of premature death mostly from a cardiovascular event during the eight year study period. It is well known that an elevated BMI increases the risk of death from heart attacks, stroke and certain types of cancers, but a cause and effect relationship proven by a well designed medical study has been elusive until now. The researchers still had some uncertainty about whether the increase in deaths could be related to smoking or other causes than obesity. So they looked at 57 studies that included over almost 900,000 people, average age 46, in Europe and North America as part of the Prospective Study Collaboration. They eliminated the first five years to control for reverse causality and smoking. The male to female ratio was 61/39 and as I said, median age 46. The mean BMI was 25 and they looked at these individuals over an eight year period and followed their BMI's and any medical events or conditions they developed. The authors found that the all-cause mortality was lowest for those with BMI's between 22.5 and 25 and increased by 30% with each increase of 5 kgs/meter squared in BMI, taking into consideration the events predetermined in the first 5 years and adjusting for smoking. They also noted that those people whose BMI's were below the normal range had a higher than normal rate of death supposedly from increases from respiratory diseases and lung cancer. The increases in deaths as people gained weight were due to a 40% increase in vascular disease, a 60-120% increase in diabetes, kidney and liver disease, and a 10% increase in cancer diagnoses.
So, as an example, if a person refrained from increasing their BMI from 24 to 32, a young adult could expect an additional 3 years of life expectancy. Alternatively, a middle age person who did not experience an increase of BMI from 28 to 32 could enjoy a 2 year increase in their life expectancy. They also stressed that it is easier to avoid weight gain than losing the weight once it has been acquired.
The take home message is the frequently heard expression that no food tastes as good as (thin)/good health and good quality of life feels. Eat healthy all! Read more.

Cancer...A Healthy Diet and Exercise Can Reduce Cancer Cases.

It is widely understood that smoking cessation can dramatically reduce the incidence of smoking-related cancers. These malignancies comprise about one third of all cancers diagnosed. However it has not been known previously if dietary changes and modifications can have a similar effect on the diagnoses of other non-smoking related cancers. A report published in the Policy and Action for Cancer Prevention evaluated the data from the public health agencies of several countries, the United Kingdom, Brazil, the USA and China. These surveys looked at the dietary habits of millions of individuals and the prevalence of cancer diagnoses and the results were collated by the World Cancer Research Fund and The American Institutes for Cancer Research and were presented to lawmakers on Capital Hill on Friday, February 27th. The writing panel from these organizations concluded that a third of all the cancers diagnosed in each of the four countries could be prevented by modifications in diet and and an increase in physical activity. They called for the so called "actors", the schools, industry, governments and individuals to take an active and aggressive role in improving the ingredients in food, removing vending machines selling unhealthy snacks, and promoting the population to exercise more and reduce sedentary activities thereby decreasing the incidence of obesity in the population.
Just to site a few examples of what a healthier diet and more physical activity could do are the reduction of prostate cancer in the US by 11% and by 20% in the UK. Another outcome would be a reduction in the diagnoses of uterine cancers by 70% in the US and a decrease of 56% in the UK as the incidence of obesity declines. The writing panel has called upon all levels of society to take an aggressive posture in rectifying our sedentary and unhealthy dietary lifestyle. These include:Governments should require widespread walking and cycling routes to encourage physical activity. Industry should give a higher priority for goods and services that encourage people to be active, particularly young people. The food industry should make public health an explicit priority. Schools should encourage physical activity and provide healthy food. Schools, workplaces, and institutions should not have unhealthy foods available in vending machines. Health professionals should lead in providing information about public health, including cancer prevention. Individuals should use independent nutrition guides and food labels to ensure they buy healthy food.
The writing group stated that there is much that can be done to decrease the rates of cancer diagnoses worldwide and the changes needed to be made are not so difficult or complicated. That is why all of us can initiate many steps, literally, to protect ourselves and decrease our own cancer risks. Go out and walk to the grocery store. Pick up some veggies and fruit and walk back home. You'll see...it does a body good! Read the entire article.

Alcohol...To Drink or Not to Drink?

Unless you live under a rock, you probably heard today about the report today coming from the Journal of the National Cancer Institute looking at 1.3 million women in England at mid-life, between the years 1996 and 2001 who were attending cancer screening clinics. They examined the effect of light to moderate alcohol consumption on the risk of developing cancer. The average amount of alcohol ingested was one drink of any type a day and they found a significant increase of several types of malignancies. The most striking increase was found in 11 additional cases of breast cancer per 1000 women over women who did not consume any alcohol at all. In addition, the investigators found increases in other cancers including, mouth, pharynx, larynx, esophagus, colorectal and liver in both sexes. Most of the previous studies looking at the association of alcohol and cancer involved men who were drinking heavily. This study is made so powerful by the shear magnitude of the subjects studied, over one million people and the length of the study, 7.2 years. if one looks at these individuals and break down the cancers according to type and percentage, the data look like this: Breast (12%, P<0.001), Oral cavity and pharynx (29%, P<0.001 for trend), Esophagus (22%, P=0.002), Larynx (44%, P=0.008), Rectum (10%, P=0.02), Liver (24%, P=0.03), Total cancer (6%, P=0.03).
The authors who were at the University of Oxford concluded that there is no safe amount of alcohol to consume as far as cancer risk is concerned. But other studies have shown that there are significant benefits as far as the cardiovascular system and cognitive functioning are concerned. So we must consider the possibility that even moderate drinking can increase our cancer risk in many of the body's organ systems and if you are a person who is at higher than normal risk of developing cancer because of a family or personal history, you may want to think carefully about whether you chose to drink. My personal opinion is that for the average healthy mid-life individual who is not at high risk for cancer, having a glass of wine or a beer a day as an accompaniment to a meal or at a celebration is a reasonable and healthy behavior. As my mother always said, "everything in moderation" is a good philosophy to adopt. Read entire article.

Coffee...Drinking Several Cups of Joe Daily May Reduce a Woman's Risk of Stroke

A recent issue of Circulation: Journal of the American Heart Association reported the findings of a group of investigators who analyzed the data from the Nurses Health Study which followed the health status of more than 83,000 nurses, mean age 56 years, all of whom were free of heart disease, diabetes, stroke or cancer at the beginning of the study. These nurses reported their health status, diet and any medical conditions or "incidents" that occurred during the study period including their consumption of caffeinated coffee. Those nurses who consumed 2-3 cups a day had a 19% reduction and those who drank 4 or more cups of coffee a day enjoyed a 20% decrease in the risk of suffering a stroke. The study followed these women for 24 years from 1980 through 2004. During this time there were women who suffered a stroke but these subjects were found to have developed high blood pressure, elevated cholesterol or diabetes. So the protective effect of caffeinated coffee appears to exist in healthy women who were non-smokers or were smokers who had quit. It has been shown in past studies that coffee may have a protective effect for the development of diabetes and high cholesterol. This association does not exist for tea and caffeinated soft drinks. So it is theorized that there are components other than caffeine in coffee that may increase the body's sensitivity to insulin, reduce inflammation and decrease the levels of a substance called "C reactive protein" which is produced by the liver in response to inflammation in any parts of the body including the coronary arteries. However the beneficial effects of coffee do not overcome the deleterious effects that smoking has on almost every part of the body.
The take home message is that for those coffee junkies who worry if they are compromising their health, they need not worry. Just remember to eliminate that cigarette you have with your cup of coffee and watch your overall health improve, not to mention the glow you will notice in your complexion! Read entire article.

Stroke...Arrival at Hospital Within an Hour Associated with Receiving Therapy which can Reduce Severity of Residual Defects.

An abstract presented at the American Stroke Association International Meeting recently reported that for those patients experiencing the onset of symptoms related to lack of blood flow to a portion of the brain, that arrival at an ER within an hour of onset increases the chance that they will have the potentially life-saving injection called tPA. This is "tissue plasminogen activator", a substance which can break up a clot within a blood vessel in the brain thereby re-establishing blood flow to a part of the brain which had been recently deprived of oxygen. They analyzed data from over 100,000 stoke patients who arrived at the hospital from a location other than being transferred from another hospital and found that about one third of them arrived within one hour from onset of stroke symptoms. Of those who arrived within an hour, 27% received tPA versus 13% who arrived between 61 and 180 minutes from onset of symptoms. One of the authors said that the goal is to achieve a time of less than 60 minutes from arrival to injection time. However, arrival in less than 60 minutes does not always guarantee that the patient will receive the tPA within a 60 minute time frame. What is happening is that the treating physicians are spending time deliberating about whether or not to give the clot buster and unfortunately, this time spent going back and forth discussing is wasting precious time. We know that the brain deprived of oxygen will cause the death of 1.9 million brain cells per minute and for every ten minutes delayed, one less patients will have a good outcome.
What is clearly needed is a team approach: one member of the team talk with and keep the family updated; another stay with, evaluate and treat the patient and the third be in charge of ordering the labs and imaging studies to facilitate a smooth transition from arrival at the ER to the administration of the tPA. As part of the informed consent before giving the tPA, the family members and patient need to be told of the potential benefits and risks which include the fact that if 100 stroke patients are treated appropriately and given tPA within an hour of onset of their stroke symptoms that 32 will have an improved outcome and 3 will have a worse prognosis.
These findings reinforce the importance of learning the early warning signs of stroke and be aware of the importance of recognizing their occurring and make sure you get the help you need to get to the nearest hospital as quickly as possible. This will optimize the chance of your being evaluated and given the life-saving drug, "tPA", which can reduce the disability of prolonged brain oxygen deficiency and even death. Read more.

Disparities Exist in Surgical Outcomes Between Black and White Patients.

Americans recently celebrated the election of the first African American to the most powerful position in the world, The presidency. But an article published in the February issue of Archives of Surgery looked at the data involving 4.7 million surgical patients at 3,270 acute-care hospitals from the year 2000 through 2005 and reported their 30 day death rates in teaching versus non-teaching facilities. The mortality for all these patients was significantly higher in non-teaching hospitals as compared with the rates of teaching institutions. But when the authors separated the patients according to race, the death rates among black patients were equal to those in teaching hospitals as compared with non-teaching hospitals and the risk of dying after a surgical complication was also equal for blacks in teaching facilities versus community hospitals. The investigators concluded that the observed improved survival in white patients in teaching facilities was not due to fewer complications but better outcome after treatment of the complication. The death rates in blacks was equal in whatever type of hospital they were operated. But whites fared better in the teaching institutions as compared to community hospitals because of several factors. Blacks tend to be living in areas that are closer to teaching hospitals where there are larger numbers of inexperienced staff who provide the bulk of care to the patients as compared to non-teaching hospitals. And it was theorized that communication problems and less accurate and comprehensive monitoring of black patients may, in part, have accounted for the lack of improved outcomes and lack of decreased mortality for black patients operated on in teaching institutions.
As healthcare providers and informed patients/healthcare consumers, it our belief that if we have a need for a surgical procedure and we are admitted to a university teaching hospital, our expectation is we will benefit from that academic environment and have a better outcome than if the procedure were performed in a community hospital. That is true for white patients, but not for blacks. We need to look more closely at this phenomenon to corroborate these findings and if they do in fact exist, conduct more careful studies to look at the specific causes of these disparities and take swift measures to correct them. Our country has indeed, come a long way in having elected an African American president. But racism and racial disparities still pervade large areas of our society and we must work diligently to close those gaps. Read more.