This week in the medical journals
By Peggy Peck
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.
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(MedPage Today) -- The "art" of medicine -- a term that doctors often fall back on when the "science" of medicine is open to interpretation -- was illustrated by studies in the leading medical journals this week.
Rush to intervention questioned
A team of Dutch researchers reported that for certain kinds of heart attacks haste in procedures to restore blood flow to the cardiac muscle does not necessarily save lives. This finding, published in The New England Journal of Medicine, comes just a week after researchers reported in The Lancet that heart attack patients who get immediate interventions have a better outcome than those in whom interventions are delayed.
In both cases the researchers were studying patients with heart attacks called non-ST-segment elevation acute coronary syndrome, which represents about 60 percent of all heart attacks. The Dutch researchers said there was no difference in one-year survival between patients who received optimized medical therapy and those who had immediate angioplasty or bypass surgery.
The finding, they said, is probably due to better drug treatments given to the patients who delayed procedures, but in the words of one expert this report is likely to make heart specialists reassess the timing of interventions, even in high-risk patients.
Specialists endorse metabolic syndrome statement
In Circulation, Journal of the American Heart Association, the American Heart Association and the National Heart Lung and Blood Institute went to great pains to explain that a grouped cluster of risk factors called metabolic syndrome is clinically significant -- which means that doctors should be diagnosing and treating this syndrome in order to prevent heart disease and diabetes.
Metabolic syndrome, the heart doctors said, is an example of the whole being greater, or this case riskier, than the sum of its parts, with the parts being risk factors like high blood pressure, abdominal fat, high levels of sugar in the blood, and low levels of HDL (good) cholesterol. People unlucky enough to have three or more of the metabolic syndrome risk factors have a significantly higher risk of developing heart attacks or diabetes, or both, according to this new statement.
But the scientific statement published this week came just a month after the American Diabetes Association and the European Association for the Study of Diabetes issued a joint statement suggesting that this group of risk factors is not greater than the sum of its parts. The diabetes groups claim the metabolic syndrome believers don't have the evidence to back up their position, so those groups are telling doctors to stick to treating individual risk factors.
COPD death rate skyrockets
For lovers of hard numbers there was some good news this week -- death is down. Well, not exactly, because death like taxes is still a sure bet. But when reckoned by age, the death rates for stroke, heart disease, accidents and cancer -- four of the six leading causes of death in the United States -- were down. The so-called age-adjusted death rate for stroke dropped by 63 percent, the heart disease death rate fell by 52 percent, the accident mortality rate declined by 41 percent, and cancer deaths declined by 2.7 percent in the past 30 years, according to epidemiologists from the American Cancer Society. They reported their findings in the Journal of the American Medical Association.
But at the same time the death rate for chronic obstructive pulmonary disease, or COPD, skyrocketed by 102.8 percent during the same period -- a chilling testament to the long-term lethal effect of cigarette smoking. Likewise diabetes deaths were up by 45 percent form 1970 to 2002, a finding that researchers say reflects the increasing number of overweight and obese Americans.
It's the blood pressure, doctor
And speaking of obesity, researchers in Paris said that while obesity plays into heart disease risk the real culprit is high blood pressure. In a study of almost 250,000 French men and women they found that overweight and obese people who didn't have high blood pressure did not have an increased rate of heart attacks, but when fat was combined with high blood pressure the risk of fatal heart attacks and strokes doubled.
Writing in Circulation, Journal of the American Heart Association, the French team said, however, that overweight and obesity usually drive up blood pressure so a good prevention strategy should target both weight and blood pressure.
Experimental drug for rheumatoid arthritis
For patients with rheumatoid arthritis an experimental drug that is just completing clinical trials may be beneficial. Orencia (abatacept) is the first in a new class of rheumatoid arthritis drugs, and a report in the New England Journal of Medicine found that about half of the patients treated with the drug, which is given intravenously, had significantly less pain and better joint mobility. Moreover, the drug was tested in patients who didn't respond to standard treatments.
Soy builds strong bones
Dietary interventions made medical news again this week with a report that diets rich in soy can reduce fracture risk in post-menopausal women. According to researchers at Vanderbilt-Ingram Cancer Center in Nashville, who studied 25,000 women living in Shanghai, China, fracture risk decreases as soy consumption increases. Women who ate the greatest amounts of soy reduced their fracture risk by 37 percent, the researchers reported in Archives of Internal Medicine.
A cry in the womb?
That first cry heard when a baby is born may not be, it turns out, the real first cry. Researchers at the Carolinas Medical Center in Charlotte, North Carolina, said that fetuses appear to cry in the womb beginning around 28 weeks of gestation. The researchers, who reported their finding in Archives of Disease in Childhood Fetal and Neonatal Edition, said that a fetus can respond to sound and other "perturbations" in the womb and the response is movements and behavior that mimic the cry of a newborn. They based the finding on ultrasound images from 10 fetuses, three of whom exhibited the characteristics of crying on two separate occasions.
She's not rude, she's a golden girl
Got a grumpy granny? It's her brain, not her personality, that may be at fault, say researchers from Sydney, Australia. As the brain ages it appears to lose the nerve cells responsible for verbal inhibition. As a result, they wrote in Psychology and Aging, the safeguards that keep us from telling strangers that they are overweight or telling a store clerk that she is "a dope" are gone. When that happens, people lose the ability to differentiate between appropriate and inappropriate remarks.
Finally, a word about breakfasts of champions. A bowl of cereal can not only give you a good start on the day, it may guarantee that you'll be thinner in the long run.
Researchers from cereal country (University of Michigan) reported that women who regularly eat breakfast are 24 percent less likely to be overweight than those who don't eat breakfast. And women who chose cereal for breakfast are 30 percent less likely to be overweight than women who skip what mom always said was "the most important meal of the day."
Take home message: Sit down and eat your breakfast!
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