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This week in the medical journals

Good news for heart disease and stroke

By Peggy Peck
MedPage Today Managing Editor

Editor's note: has a business partnership with, which provides custom health content. A medical journal roundup from MedPage Today appears each Thursday.



Medical Research
Environmental Issues
University of Washington

The good, the bad and the silly

Heart disease and stroke led the medical news this week. A handful of studies reported what works, what doesn't, and what was just a silly idea.

Super result for super aspirin

First up a study of almost 46,000 heart attack patients confirmed the value of Plavix (clopidogrel) as a life-saving treatment.

The researchers, who reported the research in The Lancet, said that 75 mg of Plavix, which is a type of super aspirin that makes the blood less sticky, plus regular aspirin, cuts the risk of death, stroke or second heart attack by 9 percent.

Plavix-aspirin combo reduces acute heart attack deaths

Waistline woes

Also in The Lancet researchers from McMaster University in Hamilton, Ontario, reported that a potbelly increases the risk of heart attack, even among people who are not considered obese using the standard body mass index (BMI) measurement.

Heart attack risk is best calculated by the waist-to-hip ratio, they wrote. In simple terms: It is safer to be pear-shaped than apple-shaped.

Apple shape predicts heart attack risk better than BMI

To sleep, perchance to snore

Also this week, researchers linked some dots between sleep apnea and heart attacks or strokes.

The studies, published in the New England Journal of Medicine, confirmed that obstructive sleep apnea increases the risk of fatal stroke, even among people who don't have high blood pressure.

A second study reported that the standard sleep apnea treatment, continuous positive airway pressure (CPAP), improves sleep quality and heart function in patients with heart failure and central sleep apnea.

But CPAP, which is a face mask that supplies continuous air pressure to keep airways open, doesn't increase survival in these patients.

Sleep disorder increases risk of mortality

Black or regular?

Popular belief and clinical lore have long identified coffee as a blood pressure trigger. But women who rely on coffee to jump start the day can lift their mugs to toast the latest finding from the 156,000-participant Nurses' Health Study.

Coffee, according to researchers from Brigham and Women's Hospital in Boston, does not contribute to long-term high blood pressure in women. But according to the report in the Journal of the American Medical Association, the blood pressure jury is still out on caffeinated colas.

Coffee doesn't increase hypertension risk, at least for women

The sunshine vitamin

Moving from strong hearts to strong bones, researchers in Reykjavik, Iceland, reported that bone health requires more than calcium.

Vitamin D, they reported in the Journal of the American Medical Association, is at least as important as calcium to maintain good bone density. They studied almost 1,000 healthy adults and found that levels of vitamin D in the blood were a marker for healthy bones, perhaps an even more important marker than calcium levels.

The recommended daily allowance for vitamin D is 400 to 800 International Units.

Vitamin D called more important for bones than dietary calcium

A nine-month workout

Exercise, meanwhile, meanwhile is essential to a healthy life, but too often women hang up their gym clothes during pregnancy, according to Saint Louis University researchers.

Although the American College of Obstetricians and Gynecologists generally recommends that women maintain a regular exercise schedule during pregnancy, only 6 percent of pregnant women work out for at least 30 minutes several times a week and just 10 percent engage in moderate exercise on regular schedule.

Worse, according to the study in Medicine & Science in Sports & Exercise, the "just do it" message is apparently "so over" for all women. Pregnant or not, fewer women were exercising in 2000 than they were in 1996.

Pregnant women are not sweating enough

No prescription needed

Speaking of unheeded messages, the Journal of the American Medical Association tried again this week to get across the idea that neither Johnny nor Jane always needs an antibiotic for every sore throat.

An analysis of records from more than seven million visits to physician offices for sore throat treatment found that physicians were writing antibiotic prescriptions for half of these children, even though two-thirds of the sore throats were caused by viral infections. Antibiotics cannot cure viral infections.

Strep or no, half of kids get antibiotics for sore throat

Bottle Baby Risk

And on the subject of healthy kids, a study in Archives of Pediatrics and Adolescent Medicine, suggested that two years of bottle-feeding may increase the risk of iron-deficiency in toddlers.

The study of more than 2,000 kids ages one to three found that the longer a child was bottle-fed, the higher the risk of iron deficiency. Toddlers who were bottle-fed beyond age two were three times more likely to develop iron-deficiency than children who were weaned from the bottle by 12 months.

Prolonged bottle-feeding a risk factor for iron deficiency

Targeting brain tumors

Molecular treatments for cancer are drugs that zero in on tumors at the cellular level and kill the cancer without harming healthy cells. They are the holy grail of cancer therapy.

Two such drugs, Tarceva (erlotinib) and Iressa (gefitinib), have been tested in a number of cancers with markedly mixed results: they either fail or, less likely, work very well.

Now, researchers at UCLA reported in the New England Journal of Medicine that they can identify the brain tumors that will respond to the treatment -- as well as tumors that won't respond.

When the brain tumor, called a glioblastoma, responds to the treatment survival can be extended to more than 21 months, versus less than six months for patients whose tumors don't respond.

Glioblastoma patients who respond to targeted therapy identified

No-so-high times

In Rheumatology this week there was a report about an experimental marijuana-based drug that leaves rheumatoid arthritis patients "feeling no pain" without inducing a high.

The experimental drug, which is called Sativex, is an oral spray that significantly reduced morning movement joint pain as well as pain at rest.

Cannabis-based drug relieves arthritis pain

When the mind rolls on

In other mellow medical news, a team of Harvard researchers reported that long term use of peyote (mescaline) among Native Americans did not increase the risk of behavioral or mental problems.

This mind-bending cultural practice does not, they wrote in Biological Psychiatry, translate into permanently altered states.

Peyote bends but doesn't alter minds

But, seriously

And finally, this week there was confirmation that women have highly developed funny bones, despite lore to the contrary. It's just that women process humor differently than men, according to a report from Stanford researchers in Proceedings of the National Academy of Sciences.

They used MRI to track the way men and women "get" the joke. Turns out, they wrote, that both sexes get the joke, but the punch line takes a different route in the female brain than in the male brain.

Endnote: The woman stops to ask for directions.

Women and men get to the joke differently

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