Archive for February, 2010

Too Few Older Adults Get Recommended Screenings

Sunday, February 28th, 2010

Screening for cancer and other preventive health measures can prolong lives, but only 25 percent of adults aged 50 to 64 in the United States are getting these recommended screenings, a new report shows.

Prepared by the U.S. Centers for Disease Control and Prevention, AARP and the American Medical Association, the report also lays out ways to improve the health of these adults by increasing the breadth of preventive services.

“This is really looking at untapped opportunities to improve the health of adults,” said report co-author Lynda A. Anderson, director of the CDC’s Healthy Aging Program. “It really talks about broadening the use of these potentially lifesaving preventive services.”

Areas of special attention in the report include influenza vaccine, cholesterol screening, colorectal cancer screening and for women, breast and cervical cancer screening. Also included are screenings for other behaviors that could hurt health such as binge drinking.

Anderson said they hope to institute programs for adults that are like those for children in keeping their health care up-to-date. “We are trying to get adults to think in the same way — are you really up-to-date- on your services?” she explained.

By 2015, middle-aged adults will make up 20 percent of the U.S. population. These people are at the greatest risk of developing chronic diseases such as heart disease and cancer. In addition, about one-third of these adults are uninsured or underinsured, increasing the challenges of providing preventive services, the report noted.

In addition, most people go to their doctor with a specific complaint and often preventive screening is never mentioned, Anderson noted. The new effort is “really looking for ways to support providers,” she said.

“This report highlights that national experts agree on a set of recommended clinical preventive services,” Dr. Matthew T. McKenna, associate director for medical affairs at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, said during a late morning news conference Thursday.

“We are talking about a concerted effort to align messages that build awareness, about creating environments that make services readily available and convenient and adopting public policies that promote healthy behaviors and increase access to services,” McKenna said. “This can make a discernable impact on our nation’s health, health care and social services.”

In addition, the report discusses model programs, policies and strategies that communities can adopt together with health-care partners, to ensure services get to those who need them. It also highlights proven strategies that clinics and communities have used to promote preventive services.

One such program, called SPARC (Sickness Prevention Achieved through Regional Collaboration), is an organization in the community responsible for looking at what services are needed and organizing these services, as well as getting services to people, Anderson said.

Individuals should look at “what kind of services do you need–what do I need to do to maximize my own health? What are the things I can do make sure as I am growing older that I avoid having chronic illnesses? That I make sure I get the physical activity I need, I make sure I am the right weight, so I can do the things I want to do,” Anderson said.

“It’s not just about health — it’s really quality of life,” she said.

Sounds May Help Solidify Memories While Asleep

Sunday, February 21st, 2010

Sounds can penetrate deep sleep and enhance associated memories upon waking, new research finds.

In a study linking sounds to what is called spatial memory, researchers at Northwestern University in Chicago showed 50 objects on a screen to study participants and played corresponding sounds, like a cat meowing and a tea kettle whistling. Then they played some of the sounds as participants napped.

The participants didn’t consciously hear the sounds, but they still did better in tests of remembering where the objects belonged on the screen.

“The research strongly suggests that we don’t shut down our minds during deep sleep,” said John Rudoy, lead author of the study and a neuroscience post-graduate student, in a news release issued by the university. “Rather this is an important time for consolidating memories.”

“While asleep, people might process anything that happened during the day — what they ate for breakfast, television shows they watched, anything,” Ken Paller, senior author of the study and professor of psychology at Weinberg College of Arts and Sciences at Northwestern, said in the statement. “But we decided which memories our volunteers would activate, guiding them to rehearse some of the locations they had learned an hour earlier.”

The new study adds to the growing research that memories are processed during sleep. And it substantiates past studies showing that the brain is active during sleep, reviewing recently acquired information and integrating it with other knowledge “in a mysterious consolidation process that sustains our memory abilities when awake,” the researchers said.

FDA Announces New Warning on Plavix: Avoid Use with Prilosec/Prilosec OTC

Sunday, February 14th, 2010

Patients should avoid using the stomach acid reducer Prilosec/Prilosec OTC (omeprazole) with the anti-clotting drug Plavix (clopidogrel), the U.S. Food and Drug Administration warned on Nov. 17.

New data suggest that when patients take both Prilosec and Plavix, Plavix’s ability to block platelet aggregation (anti-clotting effect) may be reduced by about half.

“Both of these drugs, when used properly, provide significant benefits to patients.” said Mary Ross Southworth, Pharm.D., of the Division of Cardiovascular and Renal Products in the FDA’s Center for Drug Evaluation and Research. “However, patients at risk for heart attacks or strokes who use Plavix to prevent platelet aggregation will not get the full effect of this medicine if they are also taking Prilosec.”

Plavix is used to prevent blood clots that could lead to heart attacks or strokes in at-risk patients. Omeprazole, the active ingredient of Prilosec and Prilosec OTC, is a proton pump inhibitor (PPI) used to reduce the production of stomach acid and prevent stomach irritation.

Plavix does not have anti-clotting effects until it is converted or metabolized into its active form with the help of the liver enzyme, CYP2C19. Prilosec blocks this enzyme, thereby reducing the effectiveness of Plavix.

After issuing an Early Communication in January about possible drug interactions involving Plavix, the FDA requested new studies from the drug’s manufacturers, sanofi-aventis and Bristol-Myers-Squibb. These new studies support the existence of a significant interaction that could negatively impact a person’s health. Based on the current scientific information, the Plavix label has been updated with new warnings about the use of Prilosec and other drugs that inhibit the CYP2C19 enzyme and that could interact with Plavix in the same way.

The new studies compared people who took Plavix and Prilosec together with people who took Plavix alone. A reduction in Plavix’s anti-clotting effect was found in those individuals who took the combination. Similar results were seen irrespective of whether the two drugs were taken at the same or different times of day.

It is unknown how other PPIs may interfere with Plavix. Other drugs that should not be used with Plavix because they may have a similar interaction with CYP2C19 include Nexium (esomeprazole), Tagamet and Tagamet HB (cimetidine), Diflucan (fluconazole), Nizoral (ketoconazole), VFEND (voriconazole), Intelence (etravirine), Felbatol (felbamate), Prozac, Serafem, Symbyax (fluoxetine), Luvox (fluvoxamine) and Ticlid (ticlopidine).

Patients who take Plavix and need to take a drug to reduce stomach acid should discuss their therapy with a health care professional. Zantac (ranitidine), Pepcid (famotidine), Axid (nizatidine), and antacids do not inhibit the CYP2C19 enzyme and aren’t expected to interfere with the anti-clotting activity of Plavix.

Plavix’s manufacturers have agreed to continue conducting studies to explore this and other drug interactions. When the FDA has reviewed additional data, the agency will communicate any new recommendations or conclusions.

Diuretics Still Best Treatment for High Blood Pressure

Sunday, February 7th, 2010

Tried-and-true diuretics maintain their status as the best first-line treatment in older men and women with high blood pressure, new research concludes.

The thiazide-type diuretic chlorthalidone outshone three other treatments — a calcium channel blocker, an ACE inhibitor and an alpha-receptor blocker — in most areas, especially in lowering the incidence of stroke and heart failure, according to the most current data from a large ongoing study known as ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).

“We believe thiazide-type diuretics should still be preferred,” said study investigator Dr. William Cushman, professor and chief of preventive medicine at the Veterans Affairs Medical Center in Memphis, Tenn., at a news conference on the findings Wednesday at the annual meeting of the American Heart Association (AHA) in Orlando, Fla.

“The message is largely unchanged, and the main message is that treating hypertension [high blood pressure] is very necessary,” added Dr. Clyde Yancy, president of the AHA. “Treating hypertension with chlorthalidone resulted in a significant reduction in heart failure and stroke.”

The original trial, begun in 1994, involved more than 42,000 patients with hypertension and at least one other risk factor for cardiovascular disease. The participants were randomly assigned to take one of the following anti-hypertensive drugs: chlorthalidone (the diuretic), amlodipine besylate (the calcium channel blocker), doxazosin mesylate (the alpha blocker) or lisinopril (an ACE inhibitor).

The five-year follow-up, which ended in 2002, was intended to see if new differences emerged with long-term use of the medications, especially regarding coronary heart disease, total mortality, heart failure and aggregate cardiovascular disease.

“This is the largest hypertension trial to date,” Cushman said.

Earlier results from ALLHAT had also found that diuretics were as good or better than other blood pressure-lowering drugs for treating hypertension in patients with metabolic syndrome (a collection of factors that put people at risk of heart disease), especially black patients.

“None of the newer drugs were superior to chlorthalidone for reducing death from cardiovascular disease or end-stage renal disease, although the calcium channel blocker was very similar,” Cushman stated.

Strokes were much more common in black study participants taking the newer drugs, and patients on the calcium channel blocker had much higher rates of heart failure.

Cushman also presented some 10-year follow-up data, which were essentially the same as the five-year data. No new adverse events cropped up, he noted.

“Chlorthalidone treatment is superior to each in preventing one or more major cardiovascular events as long as participants continued taking the drug,” he said.