Should all children be screened for high cholesterol?

High cholesterol is common enough in children these days that all of them should be screened for the condition, say the authors of a new study examining the rates of high cholesterol in children.

Currently, the American Academy of Pediatrics recommends screening children and teens who have a family history of premature heart disease or high cholesterol or those children who already have risk factors for heart disease, such as obesity, high blood pressure or who smoke or have diabetes. For these children, screening should start after age 2 and before age 10.

However, a sizable number of people don't have accurate information on family medical history. In the new study, released online Sunday in the journal Pediatrics, researchers reviewed data from more than 20,000 fifth-grade children in West Virginia, including examining their family history and conducting blood cholesterol tests. They found that more than 71% of the children met guidelines for cholesterol screening based on family history. Among children whose family history wasn't known, 9.5% had high cholesterol -- with 1.7% of those children requiring medication to treat the condition.

Screening all children for cholesterol, rather than just those with a family history, will uncover many more cases of the condition that can be treated early to prevent heart disease later in life, the authors said. Statin therapy has been shown to be safe and effective in lowering LDL cholesterol (the bad kind of cholesterol) levels in children.

Moreover, the authors wrote: "...the added and undeniable benefit of identifying and screening parents and other first-degree relatives as a result to finding elevated LDL levels in their children could lead to the prevention of premature cardiac events in adults that may have otherwise gone undiagnosed."

-- Shari Roan

Photo: More than 13 million Americans are taking statins to lower their cholesterol and stave off heart disease. Credit: Bob Chamberlin / Los Angeles Times

Testosterone gel linked to increase in heart problems in frail men, study finds

Many men use a testosterone supplement to treat symptoms linked to testosterone deficiency in older age, such as poor libido and deteriorating muscle strength. However, such treatment appears to come with additional health risks for frail, elderly men who use the gel to increase their strength and mobility.

Researchers reported Wednesday that a study designed to assess the risks and benefits of testosterone replacement therapy in men ages 65 and older who had mobility problems was stopped early -- in December 2009 -- because of a much higher rate of cardiovascular problems in the men receiving testosterone compared with those receiving a placebo gel.

The study, led by researchers at Boston University and funded by the National Institute on Aging, included 209 men, half of whom used testosterone gel daily for six months. The average age of the men in the study was 74. All of the men in the study had limited mobility and a high prevalence of chronic disease. However, among the 106 men using testosterone gel, 23 had cardiovascular-related events compared with only five men in the 103-person placebo gel group. The study is published online in the New England Journal of Medicine.

It's difficult to know just what to make of this study, the authors acknowledged. There was a broad range of cardiovascular events, including heart attack, stroke, death from suspected heart attack, exacerbation of congestive heart failure, atrial fibrillation, swelling, chest pain and other milder symptoms. With such a diversity of events, it's hard to pinpoint how testosterone replacement therapy may be responsible. The doses of testosterone used in the trial may have been higher than in previous testosterone studies that have not found cardiovascular risks. Moreover, the trial was small and was stopped early.

The elderly men using testosterone did show increased strength in leg-press and chest-press strength and in stair climbing while carrying a load.

As for younger and healthier men who use testosterone gel, it's doubtful this study can be applied to them, the authors said. Previous studies of testosterone gel in other groups of men have not shown significant increases in cardiovascular risks. "Caution is also warranted in extrapolating these findings to other doses and formulations of testosterone or to other populations, particularly young men who have hypogonadism without cardiovascular disease or limitations in mobility," they wrote.

However, long-term studies on the risks and benefits of testosterone therapy in men of all ages are lacking, according to a recent story in the Los Angeles Times. Meanwhile, the availability of testosterone in gel form has led to a huge jump in prescriptions in the U.S.; 3.3 million prescriptions were filled in 2008 compared to 64,800 in 1999, according to one pharmaceutical data company.

As for older men in poorer health: "The authors note that physicians and patients, especially older men, should consider this study's findings on adverse effects along with other information on the risks and benefits of testosterone therapy," officials from the NIA said in a statement. Further research is needed to clarify the safety issues raised by the trial, the authors note.

Additional trials on the risks and benefits of testosterone therapy in men are ongoing, the NIA statement said. Those trials will continue although investigators and participants will be advised of the findings of the Boston University study.

-- Shari Roan

Photo credit: Stephen Sedam  /  Los Angeles Times

Advice from American Heart Assn. for diabetics taking Avandia

If diabetics who take Avandia aren't confused by now, well, they haven't been keeping up with medical news.

On Monday, three studies were released about the side effects linked to Avandia (also known by its generic name, rosiglitazone), two of which found a worrisome rate of side effects and one that found no new safety concerns. The fate of the drug, which was approved in 1999, will be at stake in July when a Food and Drug Administration advisory committee meets to review the evidence on Avandia's safety. The drug is known to increase the risk of heart failure and bone fractures. But newer data suggest it also raises the risk of heart attacks, strokes and death.

The American Heart Assn. weighed in Tuesday with some advice for people taking Avandia.

" ...the reports deserves serious consideration, and patients with diabetes who are 65 years of age or older and being treated with rosiglitazone should discuss the findings with their prescribing physician. . .

"For patients with diabetes, the most serious consequences are heart disease and stroke, and the risk of suffering from them is significantly increased when diabetes is present. As in most situations, patients should not change or stop medications without consulting their healthcare provider."

The statement goes on to list the association's recommendations, including that the drug metformin should generally be considered the first choice for glucose-lowering drugs. There's also advice on what to do if you're already on Avandia.

-- Shari Roan

Photo: Justin Sullivan / Getty Images

Early fitness important to cutting future risk of diabetes, heart disease

Attention, college students: Get off that shuttle bus and start walking to class.

You’re already eating a diet of mainly beer and pizza, staying up all hours of the night, and living in cramped, potentially germ-infested dorms. The last thing on your mind is whether you’re setting yourself up for future cardiovascular disease or Type 2 diabetes.

Now might be a good time to start thinking about it…

A new study by Tufts University scientists found that body fat percentages are not the only precursors to health problems later in life. A person's physical fitness may matter a lot more -- at least when it comes to developing cardiovascular disease or diabetes.

Motivated in part by the astounding growth rate of obesity amongst college students -- approximately 31% of U.S. college students are overweight or obese -- researchers at Tufts' Friedman School of Nutrition Science and Policy tracked the health and health-related behaviors of 564 male and female college students over a nine-year period. They tracked body fat, fitness level and risk factors such as cholesterol and blood glucose levels.

Their findings: Students who were physically fit -- regardless of their body fat content -- had lower blood triglycerides, higher HDL (the "good" cholesterol). That effect was especially marked in women.

The fitter students also had lower blood glucose levels, an effect that was especially marked in men.

The findings are important, says Jennifer M. Sacheck, one of the study authors, because they suggest that the roots of later disease may be laid down early. "Because most of these health problems show up more often later in life, most studies have focused on adults, and very few have been done on college populations or anyone younger," she said in a phone interview.

However, she added, because students won't be tracked through their lives, there's no way to guarantee that heart disease and diabetes actually will develop in those students who look like they're heading that way.

The study does suggest that maybe we should change the way we think about health -- basing it not so much on weight and body fat composition, but more on physical fitness and the frequency of exercise.

And, Sacheck says, the message has particular importance for college students who are known to be more careless and reckless with their health than other age groups:

"In college, you think you're invincible, at the peak of your health, and that your body can handle anything. But my message [in this study] is that even at this age your body is susceptible."

For those who have long cursed the Body Mass Index, which stratifies a person's health level based on weight and height equations, this study is heartening. Perhaps it's time to stop worrying about the number on the scale and whether you can still fit in  the jeans you wore in high school, and instead pat yourself on the back for running each morning. It might seem paradoxical, but being physically active and a bit pudgy might be better than skinny and unfit.   

Here's the study abstract (the full report is available for a fee) plus a news release from Tufts laying out the nuts and bolts of the research and its findings.

And here's a link to the website of physiologist Linda Bacon, one of the proponents of health at every size.

-- Jessie Schiewe

Photo credit: Los Angeles Times

Lower cancer risk is another reason to like 'good' cholesterol

High-density lipoprotein cholesterol, otherwise known as the "good" cholesterol, is known to help protect against heart disease. The bad cholesterol, LDL, raises the risk. Now there's another reason to aim high with HDL cholesterol. A study suggests that people with higher rates have less cancer.

Researchers at Tufts University analyzed data from 24 studies that tested medications to alter cholesterol. The participants' medical records were examined for cancer incidence. The total number of participants was more than 145,000 with more than 8,000 cases of cancer reported.

But people who had higher levels of HDL (typically considered more than 40 mg/dL for men and more than 50 mg/dL for women) had a two- to three-fold lower risk of heart disease and a 36% lower risk of cancer for every 10 mg/dL higher level of HDL. This was found even when the researchers controlled for other factors that affect cancer, such as age, body mass index, diabetes, sex and smoking status.

The study does not prove that having higher HDL reduces cancer risk. It's not clear how HDL may protect against cancer, said the lead author of the study, Dr. Richard Karas. It could be HDL helps rid the body of harmful antioxidants that can damage cells and cause cancer. Or, HDL may boost the immune system to fight cancer or help quell inflammation in the body that can trigger abnormal cell growth.

Many people focus on their bad cholesterol, but it's important to remember that HDL matters too.

"Patients need to be informed and understand what each cholesterol number means for their overall health and risk of disease," Karas said in a news release.

The study was published Monday in the Journal of the American College of Cardiology.

-- Shari Roan

Become a fan of our Facebook page and get a steady stream of health-and medical-related news, musings and the occasional oddity.

Photo credit: Ricardo DeAratanha / Los Angeles Times  

Heart attacks fall in one diverse community, with perhaps lessons for others

Take detailed data (if you can get it) on heart attacks in a large, diverse patient population, do a bit of number-crunching based on patient age and gender, and see what you get. Kaiser Permanente researchers could, and did, in Northern California -- and what they got was an impressive reduction in heart attacks since 2000.

Overall, heart attacks declined 24% in patients age 30 and older. The rate of a severe type of heart attack, known as ST-segment elevation myocardial infarction, fell by 62%.

The results were published Wednesday in the New England Journal of Medicine. Here's the abstract of that heart-attack study and some details from the research division's news release.

The researchers write in their study conclusion:

"Increasing emphasis has been put on measures to reduce risk factors at the individual and community levels, including public bans on smoking and lower target levels of low-density lipoprotein (LDL) cholesterol and blood pressure; these changes have resulted in improved control of risk factors over time."

They also point out that such improvements were achieved despite the community's overall tendency to gain weight and develop diabetes.

Here's more about heart attack types, from the Cleveland Clinic. And an explainer of the two main types -- ST segment elevation myocardial infarction, or STEMI, and non-ST segment elevation myocardial infarction, or NSTEMI -- from About.com.

In the former, a blood clot blocks an artery completely (as opposed to partially), affecting more heart muscle and causing more damage.

-- Tami Dennis

Photo: The use of statins and other cardioprotective drugs, now taken by many people, certainly haven't hurt heart attack numbers, the researchers say.

Credit: Bob Chamberlin / Los Angeles Times

 

Short people have more heart disease

It's bad enough that short people can't reach the top shelves and always have to have their pants hemmed. Now, according to a new study, it turns out short people are more likely to develop heart disease.

French researchers analyzed 52 studies with a total of more than 3 million participants to see if there was a link between developing heart disease and height. They found that short adults were 1.5 times more likely to develop heart disease and die from it than were tall people. The link was true for both men and women and for all ethnic groups. Short was defined as under 5 feet 4 for men and under 5 feet for women. Tall men were defined as over 5 feet 8 and tall women over 5 feet 4.

Moreover, short men were 37% more likely to die from any cause compared with tall men, and short women were 55% more likely to die from any cause compared to taller women.

There is no explanation for why heart disease would affect short people more. But, according to the researchers, it could be that they have smaller coronary arteries which may become blocked earlier in life. It's also possible that short stature is a marker for a lower socioeconomic status, including poor nutrition and growth early in life.

"...height may be considered as a possible independent factor to be used in calculating people's risks of heart disease," the authors wrote.

But fear not, short people, said the lead author of the paper, Dr. Tuula Paajanen of the University of Tampere in Tampere, Finland, in a news release. "Height is only one factor that may contribute to heart disease risk, and whereas people have no control over their height, they can control their weight, lifestyle habits such as smoking, drinking and exercise. And all of these together affect their heart disease risk."

The study was released Wednesday in the European Heart Journal.

-- Shari Roan

Photo: Yao Ming of Houston, the NBA's tallest player at 7 feet 6, towers over the shortest, 5-5 Earl Boykins of Denver in this 2003 photo. We assume neither has heart disease. Credit: Gary C. Caskey / Reuters.

Heart failure patients are often readmitted to the hospital

Treatment for older people with heart failure has improved by several measures. Patients today have shorter hospital stays and lower rates of death while in the hospital. However, the rates of hospital readmission have increased, which may signal that care for this serious illness isn't as good as it could be.

Researchers analyzing Medicare data from 1993 to 2006 found that the average length of a hospital stay for heart failure declined from 8.8 days in 1993 to 6.3 days in 2006 while in-hospital death rates declined from 8.5% to 4.3% during the same time period.

However, the patients may be sicker when they leave the hospital. The study, released Tuesday in the Journal of the American Medical Assn., found that deaths occurring within 30 days of discharge rose from 4.3% to 6.4% over the 14 years studied. Readmission to the hospital within 30 days increased from 17.2% to 20.1% Moreover, the ratio of patients who were discharged from the hospital to skilled nursing facilities increased from 13% to 19.9%.

It's troubling to see an uptick in patients who have to be readmitted or go to skilled nursing facilities, the authors of the study noted.

"Although we cannot demonstrate that the shortened hospital stay caused these changes, it is certainly plausible that the effort to discharge patients quickly has led to transfers to nonacute institutional settings and occasionally sent patients out of the hospital before they were fully treated," they wrote.

-- Shari Roan

Photo credit: John Moore / Getty Images

Help your heart. Brush your teeth twice a day.

Good oral hygiene includes, at a minimum, brushing your teeth twice a day and visiting the dentist every six months. People who do that will not only be rewarded with better dental health, they are also less likely to develop heart disease, a study finds.

In recent years, researchers have connected the dots between inflammation in the gums and inflammation in other parts of the body, such as the heart. A study released online Friday in the British Medical Journal suggests that consistent brushing of the teeth may be a significant strategy to reduce the risk of heart disease. Researchers analyzed data from 1,100 Scottish adults and found that people who reported less frequent brushing had a 70% extra risk of heart disease, although their overall risk of heart disease was still relatively low. This association was apparent after adjusting for other factors that contribute to heart disease, such as obesity, smoking and family history of heart disease.

The people who brushed fewer than twice a day were more likely to test positive for chemical markers of inflammation in the blood, such as C-reactive protein and fibrinogen.

Overall, periodontal disease is linked to a 19% increased future risk of heart disease. But, the authors said, it's not entirely clear yet whether gum inflammation contributes to heart disease or is a marker for it.

-- Shari Roan

Photo credit: Al Seib  /  Los Angeles Times

Chronic obstructive pulmonary disease: Beta-blockers may help

Chronic obstructive pulmonary disease is rapidly becoming a leading cause of death in the United States. Experts project that in 10 years, COPD will be the third-leading cause of death in the Western world. COPD includes chronic bronchitis and emphysema and is often linked to smoking. People with COPD are at greater risk of heart disease, too.

A study published Monday, however, suggests that beta-blockers -- medications used to treat high blood pressure and heart rhythm disorders -- reduce respiratory infections and improve survival in people with COPD. In a study of 2,230 COPD patients followed for an average of 7.2 years, the patient who took a beta-blocker had lower deaths rates (27.2% compared with 32.3%) than other COPD patients and fewer serious flare-ups.

The study, published in the Archives of Internal Medicine, is the first to suggest that long-term use of beta-blockers may improve survival in COPD. Doctors may hesitate to use beta-blockers for COPD patients, however, because they fear the medications will provoke respiratory problems, according to an editorial accompanying the study. The new study is promising, but a randomized, controlled trial should be performed to confirm the strategy, an editorial accompanying the study states. Until then, "the data ... provides a rationale for the practicing physician to use beta-blockers cautiously in their patients with COPD who also have a co-existing cardiovascular condition for which a beta-blocker is required," the author wrote.

-- Shari Roan