This week in the medical journals
By Peggy Peck
Medpage Today Senior Editor
Editor's note: CNN.com has a business partnership with MedPageToday.com, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.
The heart of the story
There is more than one way to treat a clogged heart artery. There is bypass surgery, of course, to replace an artery with a vessel from elsewhere in the body. Then there is a less-invasive route, a way to thread a tiny catheter through an artery to prop open vessels with tiny flexible tubes called stents.
Now comes word that people who have two or more clogged arteries are likely to live longer if they opt for bypass surgery rather than stenting.
A team of researchers at the State University of New York at Albany reviewed records from 60,000 patients who had either bypass surgery or stenting from 1997 through 2000.
They found that patients with three diseased coronary arteries had a 36 percent increased survival compared with similar patients treated with stents.
The survival edge was 24 percent for patients with two diseased coronary arteries.
The researchers, who reported their findings in the New England Journal of Medicine, said surgery patients were also less likely to need repeat procedures, and about 27 percent of stent patients needed more stenting and 8 percent eventually required bypass surgery.
Survival edge seen for CABG over stenting
'Almost' not good enough
Before heart specialists can recommend either surgery or stenting, they need to get a good look at the vessels in the heart. This is done with an X-ray procedure called angiography in which dye is injected into the vessels and then tracked by X-ray. Since the test is invasive, it does carry some risk of injury and may -- in rare instances -- trigger a heart attack.
A team of German researchers has been testing a "virtual" angiography system that uses a multi-slice computed tomography -- CT -- scan to see the inner workings of blood vessel without placing a catheter in the heart. The results, which they reported in the Journal of the American Medical Association, suggest that the CT approach is almost -- but not quite -- as good as standard angiography.
Almost is not good enough, so for now conventional angiography will remain the gold standard. But the researchers predict that virtual angiography will soon be ready for prime time.
Multi-slice CT complements but doesn't supplant angiography
Best bet? Bypass surgery and angiography are odds-on favorites.
Turning to the medicine cabinet
Controversy surrounding one of the cholesterol-lowering drugs called statins, also made headlines this week.
A study in Circulation, Journal of the American Heart Association, reported the patients taking the super-potent statin Crestor (rosuvastatin) were more likely to develop serious side effects such as a breakdown of muscle tissue and kidney failure than patients taking Lipitor (atorvastatin), Pravachol (pravastatin) or Zocor (simvastatin).
The researchers at Tufts University based their findings on an analysis of adverse event reports from the Food and Drug Administration, but last March the FDA conducted its own analysis of the same data and reported no increased risks for Crestor.
A spokesperson for the American Heart Association emphasized that as a class statins are considered "very safe" and noted that it is riskier to stop taking the drugs, which lower LDL, the so-called bad cholesterol, than it is to take the drugs as prescribed. Nonetheless, the Tufts researchers suggest that Crestor should be the statin of last resort.
Crestor called less safe than other statins
There was no mixed message about the value of the blood thinner Coumadin (warfarin) In a study of more than 4,000 high risk patients with atrial fibrillation, an abnormal rhythm of the heart's upper chambers, Coumadin use reduced stroke risk by as much as 69 percent.
An international team of researchers said Coumadin worked to decrease stroke risk whether it is taken every day or just as needed to restore normal heart rhythm.
The American Heart Association estimates that 2.2 million Americans have atrial fibrillation, which means that the upper chambers or the heart quiver rather than beat efficiently. As a result, blood pools in the chambers and forms clots that can break off and become lodged in arteries, such as the carotid arteries that carry blood to the brain.
In the study, which was reported in Archives of Internal Medicine, the researchers said patients with atrial fibrillation had a 60 percent greater risk of stroke than patients with normal heart rhythm.
Long-term Coumadin cuts stroke risk in atrial fibrillation
Heart medications, good or bad, only do their stuff if you take them. And another study in Archives of Internal Medicine indicates that after six months about a third of patients simply stop taking drugs that lower blood pressure or cholesterol.
An analysis of medical records from more than 8,400 patients treated at a managed care organization found that patients were most likely to stop taking the drugs as the number of prescriptions increases. So patients who were supposed to take three heart drugs were less likely to take drugs as prescribed than patients who had to take only one or two drugs.
Heart patients aren't reliable pill-takers
Comment: It only works if you work it.
One drug, two diseases
Researchers at the University of Michigan, working with clinicians in Israel, say that taking statins such as Zocor or Pravachol for at least five years can reduce the risk of colorectal cancer by 47 percent, compared with people who never used the cholesterol-lowering drugs.
While there have been a number of studies that suggest statins may do double-duty in cancer and heart disease, this study is the first to report that it is the statin, not just the lower cholesterol, that appears to be reducing cancer risk.
Writing in The New England Journal of Medicine, the researchers said people who took other types of cholesterol lowering drugs, such as the fibrates Lopid (gemfibrozil) or Tricor (fenofibrate), did not reduce their risk of colorectal cancer. But the researchers say the findings need to be confirmed in a random study before doctors start recommending statins to prevent colorectal cancer.
Statin use linked to reduced risk of colorectal cancer
Meanwhile, the Journal of the American Medical Association reported that hair dye is an unlikely cause of breast or bladder cancer, but the jury is still out on cancers of the blood and bone marrow.
Cancer researchers in Spain analyzed the combined results of 79 studies to nail down any possible cancer-hair dye link. The studies dealt only with home dye jobs, not risks associated with a visit to a professional colorist.
The researchers found a "borderline" increase in risk of lymphomas and leukemia, but they said risk was mainly reported in case-control studies --which are not considered the most reliable type of clinical studies -- that included data from men as well. While calling for more studies, the researchers concluded that hair dyes don't "represent a major public health concern."
Hair dyes unlikely to cause cancer
For cancers already diagnosed and treated, survival is a major concern, and a team of Harvard researchers reported that extending breast cancer survival may be a walk in the park -- or a turn around the track at the gym.
Exercise, they reported in the Journal of the American Medical Association, can increase survival by close to 50 percent compared with women who don't exercise after treatment for breast cancer.
Even a little exercise -- walking less than an hour once a week -- can increase survival by 20 percent while moderate exercise for three to five hours a week can increase survival by 44 percent. The findings are based on data collected from 2,897 registered nurses participating in the Nurses' Health Study.
Moderate exercise extends lives of breast cancer patients
Box score: One run, three hits, two left on base.
Just say no
Finally, medical journals are loath to allow a week to pass without an obesity study, and this week was no exception.
Researchers in Glasgow, Scotland, reported that while many look upon the battle of the bulge as a lifelong struggle, the war is really all over before kindergarten.
Baby fat, it turns out, is really a predictor of middle-aged love handles. So healthy lifestyle habits, such limited or no TV time, and a diet that just says no to Twinkies may need to be initiated in the nursery, according to the report in the online issue of BMJ (British Medical Journal).
First three years of life may lay groundwork for obesity
Cookies and low-fat milk -- hold the cookies.
