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This week in the medical journals

By Michael Smith
MedpageToday.com Staff Writer

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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Forget earlier reports on pregnancy concerns, two studies published this week in major medical journals said.

Canadian researchers, reporting in the journal Fertility and Sterility, refuted a report that Femara (letrozole) causes birth defects when it is used to induce ovulation in infertile women. Femara is approved for use as an aromatase inhibitor drug to prevent the recurrence of breast cancer for postmenopausal women, but increasingly -- until Montreal researchers raised a red flag last year -- it was being given widely in fertility clinics.

That red flag was premature and based on shoddy research methods, according to Dr. Togas Tulandi of McGill University, also in Montreal. He said his data show that the drug actually is associated with fewer birth defects than its main competitor.

Femara link to birth defects disputedexternal link

And, in the New England Journal of Medicine, Australian researchers put the kibosh on the idea that vitamin supplements -- C and E -- reduce either the risk of pre-eclampsia in pregnant women or the risk of low birth-weight or death of the infant. The study involved women considered to be at normal risk for pre-eclampsia, but the findings were strikingly similar to a March study in high-risk women. Both studies followed a 1999 report suggesting that the supplements might have a beneficial effect.

Vitamin C and E supplements do not prevent pre-eclampsiaexternal link

More on obesity

From 1997 to 2003, diabetes diagnoses in the U.S. increased 41 percent, with obesity a major player, according to researchers from the Centers for Disease Control and Prevention in Atlanta. Writing in the American Journal of Preventive Medicine, the researchers said the annual increase was between 4.9 and 6.9 percent per 1,000 population. At the same time, the proportion of new diabetes cases in people who were obese rose to 59.7 percent in 2002 and 2003, compared with 51.6% in 1997 and 1998.

Obesity a prime agent in the diabetes epidemicexternal link

On the other hand, the news on the obesity front wasn't all bad: A study in the Archives of Internal Medicine said that even among the obese elderly, diet and exercise have beneficial effects, reducing weight and improving strength, flexibility and balance. The results suggest that it's never too late for a healthy lifestyle.

Diet and exercise reverse frailty in older obese patientsexternal link

Matters of the heart

Some good news emerged for coffee lovers. Drinking gallons and gallons of coffee, day in and day out, year after year, decade after decade, does not increase the risk of coronary heart disease, according to a study in the journal Circulation. In fact, men and women who drank six or more cups of coffee a day for up to 20 years had a slightly lower risk of developing coronary artery disease than those who sipped a cup or less a day.

On the other hand, coffee consumption was strongly linked to cigarette smoking, which may explain why some other studies have found a link between coffee and heart disease.

Coffee drinking does not increase risk of coronary heart diseaseexternal link

Coffee or no, some of us will suffer acute coronary problems and when we do, it's best to go to a hospital that adheres strictly to national guidelines for care, according to a report in the Journal of the American Medical Association. As adherence to guidelines increased, the death rate decreased, researchers found. On the other hand, nine key treatment guidelines recommended by the American College of Cardiology and the American Heart Association were followed in only 74 percent of cases in a survey of 350 hospitals.

Acute coronary syndrome deaths decline if hospitals follow guidelinesexternal link

And the failure rate for some implanted heart devices is relatively high, but the decision about what to do with a malfunctioning device is tricky, according to a report in the Journal of the American Medical Association. The average annual failure rate for implanted cardioverter-defibrillators (ICDs) is about 20 times higher than for pacemakers, mainly because the battery malfunctions, researchers found.

The problem is that taking the devices out can be risky. Nearly 6 percent of patients being studied that had an ICD removed after a manufacturer's recall suffered a major complication, including two deaths, and another 2.8 percent had minor complications.

When implanted heart device fails, removal is riskyexternal link

Be prepared

Patients admitted to the hospital after a stroke did better if they already happened to be taking a combination of drugs -- ACE inhibitors, antiplatelet agents, and statins -- researchers reported in the journal Neurology. Looking at the records of 210 patients who arrived at hospital within 24 hours of having a stroke, researchers found those who had been on the triple therapy had lower scores on a scale of stroke severity than patients who were on either two of the three agents, antiplatelet therapy alone, or no therapy. Also, when their brains were scanned, they had smaller areas of damage. They were also more likely to have a shorter length of stay and function better after they were discharged.

Triple-drug therapy reduces stroke severityexternal link

Well, duh!

Calcium supplements can help prevent fractures in older women -- if they take them regularly. A major study, reported in the Archives of Internal Medicine, compared calcium supplements with placebos, and results were disappointing overall. There was no real difference between the women taking calcium and women taking placebo in terms of how likely they were to break bones.

But when researchers looked at the subgroup of women who took their supplements faithfully, they found a clear benefit. They were two-thirds as likely to have fractures as women who took a placebo instead.

Noncompliance sabotages calcium supplement bone benefitsexternal link

Also on the follow-doctor's-orders front, a study in the journal Cancer showed that as time goes by, breast cancer survivors grow complacent about the need for an annual mammogram. Despite their significant risk for development of a new tumor, only 63 percent of women in the study had a mammogram during the fifth year of follow-up, compared with nearly 80 percent during the first year.

The drop-off may be a result of women switching from the care of a cancer specialist back to their general practitioner, the researchers suggested.

Many breast cancer survivors bypass annual mammogramsexternal link

Marburg progress

The deadly Marburg virus, like several other so-called filoviruses, including Ebola and Lassa fever, is both hard to treat and to prevent. But in The Lancet, Canadian and U.S. researchers reported that an experimental vaccine, already known to prevent Marburg, can also be used to treat it. In experiments with animals who were infected with the virus, the vaccine completely prevented any symptoms; all treated animals survived.

The vaccine still needs to be approved for human use, but it could be useful in laboratory accidents or to treat people exposed inadvertently as they respond to a medical crisis.

Smoking already did the damage

Smokers snuff their butts when they're being treated for cancer, but research reported in the journal Cancer suggested that it adds nothing to the therapy. Smokers with non-small-cell lung cancer who don't quit during treatment for advanced disease do no worse than those who do, according to a the report. On the other hand, the researchers found, quitting did decrease the chance of development of a second lung cancer in those few who survived the first.

Stopping smoking during lung cancer therapy no helpexternal link

Tired tale, but true

In a tour de force of research -- 14 papers in the journal Pharmacogenomics -- four teams of researchers led by the Centers for Disease Control and Prevention took on the issue of chronic fatigue syndrome. A central finding is that the syndrome -- often derided as being ill-defined and perhaps little more than a malingerer's delusion -- can actually be shown to be linked to five mutations in three genes that are related to the body's ability to handle stress.

Also, people with the syndrome have differences in genetic activity levels that affect the way they respond to stress accumulated over a lifetime, the researchers said.

Chronic fatigue syndrome linked to three genesexternal link

And finally, fat and bullying

Everybody knows the fat kid is likely to be bullied. But research suggests that bullying might be partly responsible for the fat.

One quarter of overweight children ages 8 to 18 reported significant problems with bullying, and such problems correlated strongly with self-reported depression, loneliness, anxiety, and curtailed physical activity, according to University of Florida psychologist Eric A. Storch, Ph.D., reporting in the Journal of Pediatric Psychology. Dr. Storch said overweight kids can be bullied or taunted right off the playgrounds or ball fields, making their struggles with excess pounds even worse.

Bullying may keep overweight kids off the playgroundexternal link

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