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This week in the medical journals

By Peggy Peck 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.



Health Treatment
Flu Season

With Valentine's Day looming, hearts were a popular theme in the major medical journals this week, women's hearts in particular.

The key to a woman's heart

Results from the massive Women's Ischemia Syndrome Evaluation, a study better known as WISE, at last provided evidence to explain why women with heart attacks don't have the same symptoms as men with heart attacks.

The WISE researchers, who reported their findings in the Journal of the American College of Cardiology, explained that in women, plaque, the fatty substance that clogs arteries in people with atherosclerosis, spreads out widely throughout the vessels rather than accumulating in specific areas, as is the case in men.

This diffuse disease is not evident on angiography, which is the imaging tool used to identify partially blocked or occluded vessels. Women are also more likely to have blockages in the tiny feeder vessels in the heart and to have stiffer, more inefficient aortas -- the largest artery in the heart. But, again, these defects usually elude routine diagnostic tests.

As a result, cardiologists typically are less likely to employ aggressive treatments -- like using tiny flexible tubes called stents to prop open arteries -- in women.

Bottom line: left undiagnosed and untreated, women are likely to progress to major heart attacks.

Women by the millions have undiagnosed heart diseaseexternal link

Recognizing the danger

What's more, women are unlikely to push for aggressive treatment, because about half of American women still don't know that heart disease is their number one killer. But, this is definitely a case of a "glass half full," because while just 55 percent of women know that heart disease stalks women, that is a significant improvement over 1997 when a similar survey found that only 30 percent of women identified heart disease as their number one killer, researchers from New York-Presbyterian Hospital reported in Circulation, Journal of the American Heart Association.

Women starting to get the message about heart disease risksexternal link

Fit and trim reduces risk

Also in Circulation, Harvard researchers reported that obesity trumps a sedentary lifestyle as a risk factor for heart attacks in women. Moreover, just adding workouts without losing weight won't significantly reduce the risk. The best way to ward off disease is to lose weight and increase physical activity, they said.

Obesity beats out inactivity as risk factor for heart diseaseexternal link

Right treatment, bad outcome

When women receive the appropriate treatment, for example bypass surgery to replace clogged arteries, they still are at a disadvantage, Canadian researchers reported in the same issue of Circulation. In general, women who get surgery are older, poorer, and sicker when they have their operations. As a result, compared with men, women are more likely to have recurrent chest pain after bypass surgery and are much more likely to be hospitalized for that pain or for treatment of congestive heart failure.

Morbidity after bypass surgery more common in womenexternal link

Chasing the blues away

Meanwhile, researchers at the University of Texas in Austin reported that a half hour on a treadmill can boost mood in men and women suffering from clinical depression. The exercise session is not a substitute for medical or talk therapy, but can be a useful add-on to traditional treatment, they wrote in Medicine & Science in Sports & Exercise.

Thirty minutes of exercise helps relieve major depressive symptomsexternal link

Rethinking antidepressants during pregnancy

Also on the theme of depression, women who stop antidepressants during pregnancy have about a fivefold risk of relapse, researchers from Massachusetts General Hospital reported in the Journal of the American Medical Association. The "joyous glow" that many attribute to hormonal surges during pregnancy is a nice story, but there is no evidence back it up, the researchers said. The take-home message for women and physicians is to discuss the options. Don't automatically stop the antidepressants without carefully evaluating all the risks -- to mom and baby.

Pregnant women who suspend antidepressants risk relapseexternal link

Eureka! How about quitting?

Cigarettes, on the other hand, are something that pregnant women should quit. But forget about planning to quit, just do it, advised researchers from University College London. Writing in BMJ, the British researchers said that smoking cessation for some is easier and more successful if it's on a spur-of-the-moment act.

When quitting smoking, spontaneity often worksexternal link

Confused? The cause may be in the medicine cabinet

Drugs, on the other hand, can sometimes be the problem, not the solution. That's the conclusion from a team of researchers In Montpellier, France, who reported that a number of common drugs used to treat asthma, pain, blood pressure, and Parkinson's disease may also cause dementia-like confusion in elderly patients. The drugs, which include some antihistamines, blood pressure medicines and analgesics, all have anti-cholinergic effects that can leave elderly patients with the symptoms of Alzheimer's disease, the French team reported in BMJ.

Drug side effects can befuddle elderly brainsexternal link

The tall story

Height is often considered an advantage, for example in presidential politics the taller candidate almost always wins. But shorter may be better for people with diabetes, according to a curious report from researchers in Taiwan who report that taller diabetics are more likely to have limbs amputated. They report this apparent association in the Canadian Medical Association Journal.

Taller diabetics at greater risk for amputationexternal link

The march of the bird flu

Finally, this week there were two encouraging reports about vaccines to combat avian flu, which is continuing its march from Asia into Europe.

University of Pittsburgh virologists used a reasonable and simple solution to the bird flu risk: immunize the birds, chickens in particular.

The Pittsburgh team reported in the Journal of Virology that an experimental vaccine appears to protect chickens from the H5N1 avian flu.

And days later, a team of CDC researchers reported in The Lancet that they had developed a vaccine that protected mice and other animals against the same H5N1 strain.

Endnote: Keep chickens from crossing road

Bird flu solution? Immunize the chickensexternal link

Another vaccine created to block avian flu In miceexternal link

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