BLOOD TEST PREDICTS SOME RISK OF HEART FAILURE

Two blood markers are strongly linked with the development of heart failure in individuals with mild to severe kidney disease, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). Elevations in these markers may indicate subclinical cardiovascular changes that subsequently contribute to the development of heart failure.

Patients with chronic kidney disease (CKD) are at increased risk of developing heart failure and other cardiovascular diseases. Nisha Bansal, MD, MAS (University of Washington) Amanda Anderson, PhD, MPH (University of Pennsylvania), and their colleagues conducted a study to see if certain blood tests might help identify patients at especially high risk. These tests -- which measure proteins called high-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) -- strongly predict heart failure in the general population, but their predictive utility in patients with CKD is unknown. The researchers studied 3483 patients with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study who were recruited from June 2003 to August 2008 and were free of heart failure when they enrolled. Patients were followed for a median of nearly 6 years.

Compared with participants with the lowest levels of hsTnT at the start of the study, those with the highest hsTnT levels had a nearly 5-fold higher risk of developing heart failure. Those with the highest NT-proBNP levels had a nearly 10-fold higher risk of developing heart failure compared with those with the lowest levels.

"This research is important in that it may advance the application of widely available cardiac biomarkers to identify CKD patients at the highest risk of developing heart failure, the most common cardiovascular complication in this patient population," said Dr. Bansal. "These findings suggest that hsTnT and NT-proBNP may represent distinct biological pathways that likely involve subclinical changes in the structure and function of the heart," said Dr. Anderson.

BENEFITS RISK OF YOGA FOUND FOR BIPOLAR DISORDER

Right now no one can say whether yoga provides clinical benefits to people with bipolar disorder, but in a new article in the Journal of Psychiatric Practice, researchers report survey responses they gathered from scores of people with the condition who practice yoga. What the collective testimony suggests is that yoga can be a substantial help, but it sometimes carries risks, too.

There is no scientific literature on hatha yoga for bipolar disorder," said lead author Lisa Uebelacker, associate professor (research) of psychiatry and human behavior in the Alpert Medical School of Brown University and a staff psychologist at Butler Hospital. Hatha yoga is the practice, familiar in the West, in which people move between various poses. It often includes breathing practices and meditation. "There is reason to think that there are ways in which it might be wonderful and ways in which it might not be safe. We are interested in studying hatha yoga for bipolar as an adjunctive treatment to pharmacotherapy."

The preponderance of responses from more than 70 people who answered the study's online survey were that yoga has benefits for people with bipolar disorder. When asked, "What impact do you think yoga has on your life?" the vast majority of responses were positive and about one in five respondents characterized yoga as "life changing." One even said, "Yoga has saved my life. ... I might not be alive today were it not for yoga."

Twenty-nine other respondents said yoga decreased anxiety and promoted calm or provided other emotional benefits. Calm also emerged as a specific benefit for 23 survey respondents when asked how yoga affects mania symptoms. Other benefits that were mentioned repeatedly included distraction from depressive thoughts and increased clarity of thought.

"There is clearly evidence that yoga seems to be a powerful practice for some individuals with BD," the researchers wrote in the paper. "It was striking that some of our respondents clearly believed that yoga had a major positive impact on their lives."

Throughout the survey there was also evidence that yoga could be problematic for some people with BD, although fewer people cited problems.

In response to survey questions about whether yoga has had a negative impact, for example, five respondents cited cases in which rapid or energetic breathing made them feel agitated. Another became too relaxed after a slow, meditative practice: "I fell into a relaxed state ... near catatonic as my mind was depressed already. I was in bed for three days afterward."

And like some people in general who practice yoga, 11 respondents warned that there is the potential for physical injury or pain. Another four said they became self-critical or frustrated with their performance sometimes during yoga.

"It's possible that you want to avoid any extreme practice, such as extended periods of rapid breathing," Uebelacker said. The survey also raised some concerns about heated yoga, which is consistent with evidence that the use of certain medications for bipolar disorder, including lithium and antipsychotic medications, are associated with possible heat intolerance and resulting symptoms of physical illness.

Next: a pilot clinical trial

The online survey is the first stage in a research program that Uebelacker, who has spent several years studying yoga for unipolar depression, and colleague Lauren Weinstock, an expert in bipolar disorder, are developing to examine yoga for bipolar disorder. They now have a grant from the Depressive and Bipolar Disorder Alternative Treatment Foundation to run a pilot clinical trial in which they will compare outcomes from yoga to outcomes from using a well-regarded workbook for bipolar disorder.

Those results could set the stage for a larger trial with enough statistical power to rigorously identify benefits and risks, Uebelacker said.

For many bipolar patients, symptoms persist for decades despite multiple medications. The current studies of yoga, Uebelacker said, are part of a broader program at Butler and Brown to determine what else can help people who are already undergoing conventional therapies.

"We're looking at alternative ways to cope with suffering that is part of people's everyday lives so that there are other options in addition to ongoing medication and psychotherapy" Uebelacker said.

As their research continues, they will learn what role hatha yoga might play.

STAINS INCREASE BREAST CANCER RISK

A new study has revealed that long-term use of controversial heart drug statins can aggravate breast cancer risk.

The Royal College of General Practitioners and the British Medical Association are currently mounting an official challenge to the decision over concerns about the side effects of long term statin use, the Daily Express reported.

Dr. Clare Gerada, former chairwoman of the Royal College of GPs said that the link with breast cancer and statins was worrying and they did not know the impact of these drugs on millions of people taking statins for up to 40 years.

The authors concluded that the contemporary population-based case-control study, long-term use of statins was associated with increased risks.

The new study is published in the journal Cancer Epidemiology.

PROSTATE CANCER RISK REDUCED BY SLEEPING WITH MANY WOMEN BUT NOT INCREASED WITH MANY MEN

Compared to men who have had only one partner during their lifetime, having sex with more than 20 women is associated with a 28% lower risk of one day being diagnosed with prostate cancer, according to researchers at the University of Montreal and INRS -- Institut Armand-Frappier. However, having more than 20 male partners in one's lifetime is associated with a twofold higher risk of getting prostate cancer compared to those who have never slept with a man

Marie-Elise Parent and Marie-Claude Rousseau, professors at university's School of Public Health, and their colleague Andrea Spence, published their findings in the journal Cancer Epidemiology. The results were obtained as part of the Montreal study PROtEuS (Prostate Cancer & Environment Study), in which 3,208 men responded to a questionnaire on, amongst other things, their sex lives. Of these men, 1,590 were diagnosed with prostate cancer between September 2005 and August 2009, while 1,618 men were part of the control group.

Risk associated with number of partners 

Overall, men with prostate cancer were twice as likely as others to have a relative with cancer. However, evidence suggests that the number of sexual partners affects the development of the cancer.

Consequently, men who said they had never had sexual intercourse were almost twice as likely to be diagnosed with prostate cancer as those who said they had. When a man has slept with more than 20 women during his lifetime there is a 28% reduction in the risk of having prostate cancer (all types), and a 19% reduction for aggressive types of cancer. "It is possible that having many female sexual partners results in a higher frequency of ejaculations, whose protective effect against prostate cancer has been previously observed in cohort studies," Parent explained.

According to some studies, the underlying mechanism of this protective effect is in reducing the concentration of cancer-causing substances in prostatic fluid or lowering the production of intraluminal crystalloids. It should be noted that for all participants, the age at which they first had sexual intercourse or the number of sexually transmitted infections (STIs) they had contracted did not affect the risk of prostate cancer. Moreover, only 12% of all participants reported having had at least one STI in their lifetime, which is few.

Male partners and increased risk 

The data indicate that having only one male partner does not affect the risk of prostate cancer compared to those who have never had sexual intercourse with a man. On the other hand, those who have slept with more than 20 men are twice as likely to be diagnosed with prostate cancer of all types compared to those who have never slept with a man. And their risk of having a less aggressive prostate cancer increases by 500% compared to those who have had only one male partner.

Parent and her team can only formulate "highly speculative" hypotheses to explain this association. "It could come from greater exposure to STIs, or it could be that anal intercourse produces physical trauma to the prostate," Parent said.

Avenues for further research 

Parent, Rousseau, and Spence are specialists in prostate cancer and are the first research team to suggest that the number of female partners is inversely associated with the risk of developing cancer.

"We were fortunate to have participants from Montreal who were comfortable talking about their sexuality, no matter what sexual experiences they have had, and this openness would probably not have been the same 20 or 30 years ago," Parent explained. "Indeed, thanks to them, we now know that the number and type of partners must be taken into account to better understand the causes of prostate cancer." Does this mean public health authorities will soon be recommending men to sleep with many women in their lives? "We're not there yet," Parent said.

ARE CHILDREN WHO PLAY VIOLENT VIDEO GAMES AT GREATER RISK FOR DEPRESSION

While much attention has focused on the link between violent video game playing and aggression among youths, a new study finds significantly increased signs of depression among preteens with high daily exposure to violent video games. The details and implications of this important new study are described in Cyberpsychology, Behavior, and Social Networking, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers

Susan R. Tortolero, PhD and coauthors from The University of Texas Health Science Center at Houston School of Public Health, RAND Corporation (Santa Monica, CA), The University of Alabama at Birmingham, Centers for Disease Control and Prevention (Atlanta, GA), and Boston Children's Hospital and Harvard Medical School (Boston, MA) recorded significantly more depressive symptoms over the course of a year among fifth-graders from three U.S. cities who reported playing high-violence video games for 2 or more hours a day, compared to those who reported playing low-violence video games for less than 2 hours a day. This association was consistent across all racial/ethnic subgroups and among boys, according to the study results presented in the article "Daily Violent Video Game Playing and Depression in Preadolescent Youth."

"One of the strengths of this study is its large and ethnically diverse sample," says Editor-in-Chief Brenda K. Wiederhold, PhD, MBA, BCB, BCN, Interactive Media Institute, San Diego, California and Virtual Reality Medical Institute, Brussels, Belgium

SEVERITY OF SLEEP APNEA IMPACTS RISK OF RESISTANT HIGH BLOOD PRESSURE

A new study shows a strong association between severe, untreated obstructive sleep apnea and the risk of elevated blood pressure despite the use of high blood pressure medications.

The study involved patients who had cardiovascular risk factors or established heart disease and moderate or severe obstructive sleep apnea. Among participants prescribed at least three antihypertensives including a diuretic, resistant elevated blood pressure was more prevalent in those with severe sleep apnea (58.3 %) compared with moderate sleep apnea (28.6%). Further analysis found that the odds of resistant elevated blood pressure were four times higher in participants with severe, untreated obstructive sleep apnea even after adjusting for potential confounders such as body mass index, smoking status, diabetes mellitus, and cardiovascular disease (adjusted odds ratio = 4.12).

"Our findings suggest that severe obstructive sleep apnea contributes to poor blood pressure control despite aggressive medication use," said first author Dr. Harneet Walia, assistant professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. "This is an important finding from a clinical perspective as poor blood pressure control in patients taking multiple antihypertensive medications makes them particularly vulnerable to increased cardiovascular risk."

Study results are published in the Aug. 15 issue of the Journal of Clinical Sleep Medicine, which is published by the American Academy of Sleep Medicine.

"High blood pressure that is resistant to treatment with medications is a strong warning sign for the presence of obstructive sleep apnea, a chronic disease that increases the risk for heart disease and stroke," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler. "Over one-third of patients with hypertension and nearly eight out of 10 patients with treatment resistant hypertension have obstructive sleep apnea. People who have high blood pressure should talk to a doctor about their risk for sleep apnea."

Data were analyzed from the baseline examination of the Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study, a four-site randomized controlled trial comprising patients with moderate to severe OSA who were under cardiovascular disease management. The analysis involved 284 participants, of which 73 were prescribed an intensive antihypertensive regimen.

"Even under the close care of a cardiologist following national guidelines for treatment of cardiovascular risk and comprehensive medication regimens, severe levels of obstructive sleep apnea versus a moderate level of OSA appear to be contributing to suboptimal blood pressure control," said Walia.

According to the Centers for Disease Control and Prevention, about 36 million American adults with high blood pressure don't have it under control. The American Academy of Sleep Medicine reports that approximately 80 percent of people with drug-resistant high blood pressure have obstructive sleep apnea, which involves repetitive episodes of complete or partial upper airway obstruction occurring during sleep despite an ongoing effort to breathe.

HEALTHY LIFESTYLES REDUCES BOWEL CANCER RISK IN MEN

Men who opt for multiple healthy lifestyle behaviours are at less risk of developing bowel cancer than women, a significant study shows.

The study analysed data of 347,237 men and women from 10 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study using a healthy lifestyle index.

Over the 12-year study period, 3,759 cases of bowel cancer were recorded.

"These data provide additional incentive to individuals and medical professionals to invest in healthy lifestyle initiatives. The more healthy lifestyle changes, the better," said lead study author Krasimira Aleksandrova from German Institute of Human Nutrition Potsdam-Rehbruecke.

Bowel cancer is the second most common cancer in men and the third most common cancer in women worldwide, mostly in developed countries.

"Our data confirmed that with an increasing number of healthy lifestyle behaviors the risk that a person will have of developing bowel cancer decreases," Aleksandrova noted.

"Our results particularly demonstrate the potential for prevention in men who are at a higher risk of bowel cancer than women," concluded Aleksandrova.

The study appeared in the journal BMC Medicine

ELEVATED CHOLESTEROL TRIGLYCERIDES MAY INCREASE RISK FOR PROSTATE CANCER

Higher levels of total cholesterol and triglycerides, two types of fat, in the blood of men who underwent surgery for prostate cancer, were associated with increased risk for disease recurrence, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

"While laboratory studies support an important role for cholesterol in prostate cancer, population-based evidence linking cholesterol and prostate cancer is mixed," said Emma Allott, PhD, postdoctoral associate at Duke University School of Medicine in Durham, North Carolina. "Understanding associations between obesity, cholesterol, and prostate cancer is important given that cholesterol levels are readily modifiable with diet and/or statin use, and could therefore have important, practical implications for prostate cancer prevention and treatment.

"Our findings suggest that normalization, or even partial normalization, of serum lipid levels among men with dyslipidemia [abnormal lipid profile] may reduce the risk of prostate cancer recurrence," said Allott.

Allott, Stephen Freedland, MD, associate professor of surgery at Duke University School of Medicine, and colleagues, analyzed data from 843 men who underwent radical prostatectomy after a prostate cancer diagnosis and who never took statins before surgery. They found that those who had serum triglyceride levels of 150 mg/dL or higher had a 35 percent increased risk for prostate cancer recurrence, when compared with patients who had normal levels of triglycerides. Among those with abnormal blood lipid profile, for every 10 mg/dL increase in total serum cholesterol above 200 mg/dL, there was a 9 percent increased risk for prostate cancer recurrence.

For every 10 mg/dL increase in high density lipoprotein (HDL; known as "good" cholesterol) among men with abnormal HDL (below the desirable value of 40 mg/dL), the risk for prostate cancer recurrence was lowered by 39 percent.

"Given that 45 percent of deaths worldwide can be attributed to cardiovascular disease and cancer, with prostate cancer being the second most common cause of male cancer deaths in the United States, understanding the role of dyslipidemia as a shared, modifiable risk factor for both of these common causes of mortality is of great importance," she added.

Study subjects were identified from the Shared Equal Access Regional Cancer Hospital (SEARCH) database and treated at one of the six Veterans Affairs Medical Centers in California, North Carolina, and Georgia.

Of the 843 men studied, 343 were black, 325 had abnormal cholesterol levels, 263 had abnormal triglyceride levels, and 293 had a biochemical recurrence, defined as rising PSA levels after prostate cancer treatment, indicating the recurrence of the patient's prostate cancer.

RADIATION THERAPY FOR CERVICAL CANCER INCREASES RISK FOR COLO RECTAL CANCER

Researchers at the University of Texas Medical Branch at Galveston are the first to recommend that young women treated with radiation for cervical cancer should begin colorectal cancer screening earlier than traditionally recommended.

The UTMB researchers, finding a high incidence of secondary colorectal cancers among cervical cancer survivors treated with radiation, offer new recommendations that the younger women in this group begin colorectal cancer screening about eight years after their initial cervical cancer diagnosis instead of waiting until age 50. The study is now online in the journal Medical Oncology.

An estimated 18 percent of malignancies in the United States are secondary cancers that develop in cancer survivors. Previous studies have indicated that cervical cancer survivors treated with radiation have an increased risk for second primary malignancies, yet no preventive recommendations have been established.

The UTMB study analyzed 64,507 cervical cancer cases collected from 1973-2009 by the National Cancer Institute Surveillance, Epidemiology and End Results program. Among cervical cancer survivors studied, colon, rectum and anus tumors were found to be two to four times more frequent in the group treated with radiation than in the group not treated with radiation. A breakdown of the findings include:

More than half (52.6 percent) the cervical cancer patients studied received radiation treatment. Colon cancer among those treated with radiation began appearing at significantly higher rates approximately eight years later.

After eight years, the risk for developing colon cancer was double for women who received radiation compared to those who had not.

Their risk of rectal cancer quadrupled after 15 years.

After 35 years, women who had received cervical cancer radiation therapy were three to four times more likely to have developed colorectal cancers than women who had not.

"We are confident from our study that it is time to consider new colorectal cancer screening strategies for cervical cancer survivors," said UTMB's Dr. Ana M. Rodriguez, assistant professor of obstetrics and gynecology and lead author of the study.

"As more people are surviving their cancer diagnosis, we need to learn more about the outcomes 10, 20, 30, even 40 years later and how to take care of their long-term medical needs."

PEOPLE WITH MULTIPLE SCLEROSIS MAY BE AT INCREASED RISK OF DEVELOPING CANCER

Individuals with multiple sclerosis may have an increased risk of developing any type of cancer, with an especially high risk of developing breast cancer. That is the conclusion of a recent study published inEuropean Journal of Neurology. Because the findings contradict earlier studies, additional research is needed to determine whether a true link exists between multiple sclerosis and cancer

Previous research suggests that some individuals with autoimmune diseases may have an increased risk of developing cancer, but most studies have found no link between cancer and multiple sclerosis, an autoimmune disease that involves the central nervous system.

To investigate further, Li-Min Sun, MD, of the Zuoying Branch of Kaohsiung Armed Forces General Hospital in Kaohsiung, Taiwan, and his colleagues assessed data from the National Health Insurance System of Taiwan, including information on 1292 patients who were diagnosed with multiple sclerosis between 1997 and 2010. Each patient was matched with four participants without the condition.

"Our study was a nationwide population-based cohort study, and it revealed unexpected findings," said Dr. Sun. Specifically, the team found that individuals with multiple sclerosis were 85% more likely to develop cancer than the controls. Their risk of developing breast cancer was especially high, with more than a 2-fold increased risk over controls.

The findings suggest that patients with multiple sclerosis patients may need to be monitored closely to ensure early detection of cancer. Dr. Sun notes that it is unclear why his team's results are not consistent with most other studies. "The underlying genetic and environmental factors in Taiwan, which differ from those of western countries, might play an undetermined role. Additional large-scale studies will help improve our understanding," he said.

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BOWEL CANCER RISK REDUCED BY ADOPTING MULTIPLE HEALTHY BEHAVIORS

Adoption of a combination of five key healthy behaviors is associated with a reduction in the risk of developing bowel cancer. Researchers from the German Institute of Human Nutrition Potsdam-Rehbruecke quantified the impact of combined multiple healthy lifestyle behaviors on the risk of developing bowel cancer, and found that this impact is stronger in men than in women.

Lead author, Krasimira Aleksandrova, says: "These data provide additional incentive to individuals, medical professionals and public health authorities to invest in healthy lifestyle initiatives. Each person can contribute a lot to avoid cancer, the more healthy lifestyle changes, the better."

Bowel cancer, also called colorectal cancer, is the second most common cancer in men and the third most common cancer in women worldwide, with 55% cases occurring in developed regions such as North America and Western Europe. Previous studies have identified links between the cancer frequency rates and western lifestyles. However, most research has focused on isolated lifestyle behaviors, such as eating red meat, while little is known about the combined impact of lifestyle factors beyond their individual effects.

The research published in the open access journal BMC Medicine analyzed the data of 347,237 men and women from 10 countries from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study using a healthy lifestyle index. Over the 12-year study period, 3,759 cases of bowel cancer were recorded.

The healthy lifestyle index was composed by the following lifestyle factors: a healthy weight; low abdominal fat; participating in regular physical activity; not smoking and limiting alcohol; and a diet high in fruits, vegetables, fish, yoghurt, nuts and seeds, and foods rich in fiber, and low amounts of red and processed meat. For each of the five behaviors, study subjects were assigned one point for having the healthy factor and zero for not having the healthy factor. These points were then summed to generate a cumulative score for each participant.

Krasimira Aleksandrova, says: "Our data confirmed that with an increasing number of healthy lifestyle behaviors the risk that a person will have of developing bowel cancer decreases."

The researchers found that the more healthy lifestyle factors the cohort adopted, the lower their risk of bowel cancer. Compared to people who had followed up to one healthy lifestyle behavior, those who practiced a combination of two, three, four and all the five healthy behaviors had a 13%, 21%, 34% and 37% lower risk of developing bowel cancer, respectively. The authors noted a difference between men and women.

Krasimira Aleksandrova, says: "Estimates based on our study populations suggest that up to 22% of the cases in men and 11% of the cases in women would have been prevented if all five of the healthy lifestyle behaviors had been followed. Our results particularly demonstrate the potential for prevention in men who are at a higher risk of bowel cancer than women."