Monthly Archive
Cancer, Diabetes, Heart Disease, New Study
The National Center for Health Statistics released the statistics on the number of deaths in 2004. The results document the biggest drop in the American death rate in almost 70 years.
The findings are summarized in this AP article.
The center said drops in the death rates for heart disease, cancer and stroke accounted for most of the decline.
“We were surprised by the sharpness of the decrease. It’s kind of historical,” said statistician Arialdi Minino, lead author of the report.
The government also said that U.S. life expectancy has inched up again to 77.9 years, a record high but still behind that of about two dozen other countries.
This is terrific news. It suggests that the new treatments in the last few decades for high blood pressure, high cholesterol and diabetes are finally making a difference in decreasing the death rate from stroke and heart disease. The fact that the death rates from cancer are also decreasing may be a tribute to the increased focus on cancer screening and early detection.
We can hope that this trend continues in the future.
The National Cancer Institute Study of Tamoxifen and Raloxifene (STAR) Trial has just concluded. It was one of the largest breast cancer prevention studies ever. It found that raloxifene, which is usually used for osteoporosis, is as effective as tamoxifen in preventing breast cancer in post-menopausal women who are at high risk of breast cancer. Raloxifene also had fewer side effects.
This study has generated much press attention and is sure to impact the lives of thousands of women who are currently taking tamoxifen. You may review the STAR Trial home page here, or read this Reuters article about the results.
Yesterday’s issue of the Archives of Internal Medicine published the final study of the Women Health Initiative (WHI), the largest trial examining the benefits and risks of estrogen replacement therapy in post-menopausal women. The news is not good.
The results of the study are reviewed in this Forbes.com article.
Previous studies on the WHI data showed that combination therapy with estrogen and progesterone increased the risk of stroke and blood clots in veins. At that time many physicians still defended estrogen replacement therapy, proposing that it is likely the progesterone that causes these increased risks. They were wrong.
This latest study looked at women who were randomized to take estrogen alone (without progesterone) versus a placebo. The women taking estrogen had an almost 30 percent higher risk of venous blood clots then the women on placebo. That was about one additional blood clot for every 200 women taking estrogen.
The risk of estrogen therapy is now undeniable. Its continued use for osteoporosis, for which other safer medications exist, can no longer be justified. It should only be used to treat severe symptoms of menopause (such as hot flushes, sleep disturbance) that the patient finds intolerable. Even in these cases the lowest dose of estrogen should be used and frequent attempts should be made to wean the estrogen off.
I’ve been quite surprised by the hesitancy of some practitioners to act on this data. Many patients are hearing mixed messages from physicians that the risks are small or that the health benefits are worth it. These claims should no longer be made.
If you or a loved one is still taking estrogen replacement, bring this study to the attention of your internist. If the estrogen isn’t being used to treat intolerable hot flushes or sleep disturbance, consider (with your doctors advice) slowly tapering the estrogen off.
Last week’s Chicago Tribune featured an important article about transient ischemic attacks (TIAs), commonly known as mini-strokes. TIAs, just like strokes, occur when a part of the brain is cut off from its blood supply, causing that part of the brain to stop working. The only difference between a TIA and a stroke is that the symptoms in a TIA are temporary, lasting usually just a few hours. Because most TIAs and strokes are not painful, many patients do not seek medical attention if the symptoms resolve. This is very dangerous. TIAs are frequently early predictors of larger strokes and every TIA or stroke should be treated as a medical emergency. Prompt medical intervention frequently makes the difference between complete recovery or permanent disability or death.
Please read the entire article. The last section lists the most common symptoms associated with TIA. I’ve reproduced that list below. Any of those symptoms should prompt you to go immediately to the nearest emergency department.