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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.

Shrinking heart disease



Health Organizations
Medical Research

The "lower is better" cholesterol story has been around for decades, but this week researchers reported in the New England Journal of Medicine that a lifetime of low cholesterol looks like a superior way to avoid heart disease.

Mutations in a gene that regulates cholesterol metabolism in the liver was associated with LDL (bad) cholesterol levels that averaged 28 percent lower in blacks and 15 percent lower in whites, according to the researchers from the Howard Hughes Medical Institute in Dallas. In blacks that reduction dropped the risk of coronary artery disease by 88 percent, and in whites the lower LDL cholesterol halved the risk of heart disease.

Only a handful of people have the cholesterol-lowering gene, but diet, exercise and cholesterol-lowering drugs could help young, healthy Americans achieve similar lows. Such lifetime lows could shrink the national heart disease problem to an easily manageable size.

Lifelong low cholesterol slashes risk of coronary heart diseaseexternal link

Human airways don't welcome bird flu

Also on the health radar is the specter of birds flying toward North America, possibly birds carrying a flu virus.

This week there was a bit of reassuring news on that front. A team of University of Wisconsin researchers reported that the avian flu may not be quite the threat it has seemed.

It turns out, according to the study in Nature, that the human airway, which is usually quite welcoming to flu bugs, is not hospitable to the avian flu virus. Instead, bird flu cells are mainly found deep in the lungs, which is probably why the flu has not yet shown signs of human-to-human transmission. But things could change.

Human lungs resist avian flu infectionexternal link

New insights into depression therapy

We know a lot more about treating depression this week than we did last week, courtesy of a massive federally funded study so big it took two journals to handle. Part was reported in the Journal of the American Medical Association, and the rest was published in the New England Journal of Medicine.

In JAMA, researchers reported that treating depression in mothers has the added benefit of reducing anxiety, disruptive behaviors and depressive symptoms in their children as well.

The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) also found that successful treatment may require adding a second drug or switching to a different drug.

The take-home message, the researchers said, is simple: If at first you don't succeed, keep trying.

Treating depressed moms brightens children's livesexternal link

Antidepressant switch or add-on produces more remissionsexternal link

Getting to the heart of women's health

Women's health was the theme of this week's Journal of the American Medical Association.

JAMA provided evidence that chest pain, or angina, is more common in women than in men and it is a dangerous symptom because it signals a significant increase in the risk of heart attack.

A team of English researchers wrote that angina is often the first sign of heart disease in women and is associated with an increased risk of death form heart disease.

Angina in women signals heart attack riskexternal link

The picture is different for sudden cardiac death, the term used to describe an electrical misfiring that causes the heart to stop without warning.

Women, according to Harvard researchers who reported their findings in the JAMA theme issue, have a very low risk of sudden cardiac death, and that risk can be lowered even further if women work out at least four hours a week.

Workouts linked to lowered risk of sudden cardiac death in womenexternal link

Accuracy of gene tests questioned

A troubling finding from the same issue of JAMA raised questions about the accuracy of commercial tests used to identify genes that increase the risk of breast cancer.

A University of Washington cancer researcher reported that the standard tests for the BRCA1 and BRCA2 genes miss about 12 percent of patients with these mutations. The standard test also missed about 5 percent of women who had other mutations that increased their risk of breast cancer.

Breast cancer gene mutations may elude standard testsexternal link

The right choice

In other breast cancer news, researchers at Wake Forest University reported that women who ask for radical surgery -- in this case, surgery to remove both breasts when cancer is found in one -- don't regret that decision in later years.

Writing in the Journal of Clinical Oncology, the researchers reported that 76 percent of women who had that procedure were pleased with their quality of life and had no second thoughts years later.

Women who choose second mastectomy feel no regretsexternal link

Size matters

And a report in the online journal Breast Cancer Research suggested that breast asymmetry may be an independent predictor of breast cancer risk.

A team of researchers from the University of Liverpool found that asymmetry, defined as a 100-milliliter difference in breast size, was associated with a 50 percent increase in the risk of breast cancer compared with the risk in women whose breasts were more evenly matched.

Breast asymmetry linked to increased cancer riskexternal link

Herbal benefit

Another study found that ginseng may increase survival and improve quality of life in women with breast cancer.

But the study, reported in the American Journal of Epidemiology, involved about 1,500 breast cancer patients in Shanghai, China -- not a perfect match for American women.

Ginseng appears to help breast cancer patientsexternal link

How low can you go?

Moving from breast to prostate cancer, a report in the International Journal of Radiation Oncology Biology Physics suggested that men who achieve low levels of prostate specific antigen (PSA) after radiation therapy for localized prostate cancer have a better outcome than men in whom PSA doesn't decline to less than 5 ng/mL.

But just as important, said researchers from the multicenter study of almost 5,000 men, is the time it takes to reach that low.

Men whose PSA continued to decline for at least two years did better than men in whom PSA quickly dropped to its lowest level.

Nadir PSA plus time to nadir predict post-radiation prostate cancer survivalexternal link

More reasons to kick the habit

Smoking, no surprise here, is bad for your health, and a trio of studies delivered variations on that theme.

First, recovering alcoholics are likely to have a harder time if they keep smoking. That finding, which may be surprising to those familiar with the movie-driven image of AA meetings in smoke-filled rooms, was reported in Alcoholism: Clinical and Experimental Research, by a team of researchers at the San Francisco VA Medical Center.

Smoking may hinder brain's recovery from alcoholismexternal link

A second study explained why there are so few old smokers: they die in middle age.

So said researchers in Norway who reported that smoking shortens women's lives by about a year and half, and takes about three years off the life expectancy of men.

Bottom-line, they wrote in Annals of Internal Medicine, is that smoking more than doubles the risk of dying between ages 40 and 70.

For smokers ages 40 to 70, the mortality risk escalatesexternal link

And finally, smoking can ruin your love life, or at least put a big a dent in your sex life.

A team of Australian epidemiologists surveying almost 8,000 men ages 18 to 59 found that 40 percent of men who smoke more than a pack of cigarettes a day develop erectile dysfunction.

The ED risk, they reported, starts with the first puff, because the risk for impotence is 24 percent higher even for men who smoke less than a pack a day, compared with nonsmokers.

End note: Don't let smoke get in your eyes.

Pack-a-day smokers increase risk of erectile dysfunctionexternal link

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