Exercise Helps Patients With Heart Failure Fight Depression

Structured exercise training (ET) may decrease depressive symptoms, resulting in improved long-term survival, in patients with heart failure, according to a study published in the January issue of The American Journal of Cardiology.

Richard V. Milani, M.D., of the Ochsner Clinical School-The University of Queensland School of Medicine in New Orleans, and colleagues studied the effects of structured ET on patients with heart failure due to coronary heart disease, including 151 patients who completed the ET program and 38 who dropped out of rehabilitation without ET. Participants completed questionnaires about their depressive symptoms at baseline and after the structured ET program was completed.

The researchers found that the patients' overall rates of depressive symptoms decreased by 40 percent after ET, from 22 to 13 percent. They also found that patients who were still depressed after ET had mortality rates that were four times higher than those whose depressive symptoms resolved after exercise, and that depressed patients who remained in the ET group had a 59 percent lower mortality rate than those who dropped out.
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Diabetes: Poor Response to Anti-Anemia Drug Predicts Higher Risk of Heart Disease or Death

The results suggest that testing such patients' responsiveness to the drug and keeping blood iron levels a little low might reduce their risk, said Dr. Robert Toto, professor of internal medicine and clinical sciences and a senior author of the study, which appeared in the New England Journal of Medicine.

"These patients required higher doses and ended up having lower hemoglobin anyway," Dr. Toto said. "The results of this study might lead us in directions that can help."

The results were an unexpected finding of a study on darbepoetin alpha, which stimulates the production of red blood cells to counteract anemia. The drug, manufactured by Amgen, is sold under the name Aranesp.

The study, called the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) showed that darbepoetin alpha works no better than a placebo for improving cardiovascular and kidney outcomes, but it did lower the risk for blood transfusion and resulted in modest improvement in patient-reported outcomes among people with diabetes, kidney disease and anemia. However, people receiving darbepoetin alpha had nearly a twofold higher risk for stroke. Cancer deaths were also higher among people receiving the drug.

Darbepoetin alpha is one of a class of anti-anemia drugs that mimics erythropoietin, the body's natural hormone that stimulates production of red blood cells.

The combination of type 2 diabetes, chronic kidney disease and anemia affect about 1 million people in the U.S.

TREAT was a double-blinded experiment with a control group that received a placebo. It included 4,038 participants, all of whom had type 2 diabetes, anemia and kidney damage, although not enough to require dialysis. Of these, 1,872 received injections of the drug, and 1,889 received placebo injections.

Participants receiving darbepoetin alpha also received periodic subcutaneous injections of the drug with the aim of increasing their levels of hemoglobin -- a protein in red blood cells that carries oxygen -- to a level of 13 grams per deciliter. If someone in the control group dropped to a dangerous hemoglobin level below 9 g/dl, he or she received "rescue therapy" with darbepoetin until the hemoglobin level returned to a level above 9 g/dl.

In analyzing the results, the researchers divided the participants into two groups: those whose hemoglobin levels promptly increased in response to early doses of darbepoetin alpha, and those whose bodies responded less strongly, with hemoglobin level staying low.

The participants who had poor initial responses to the drug had a higher rate of death, heart attack, stroke or heart failure, the researchers found.

The study cannot show whether those people had higher risk for those outcomes because they were in poorer health to begin with, or because of some action of the drug, the researchers stated.

However, it does raise the question of whether treatment for anemia should be customized according to a patient's response to the drug, Dr. Toto said.

"Our studies suggest that we might be able to use the initial dose response to identify high-risk groups in future studies," he said.

For instance, if a person's hemoglobin level doesn't improve within one or two months of anti-anemia treatment, it may be better to stop the drug and seek alternative treatment. A state of mild anemia might pose less cardiovascular risk in such a case than continuing or escalating the dose in an attempt to reach a normal hemoglobin level, Dr. Toto said. Conversely, for patients who respond quickly to the drug, treating them until they reach the normal goal range recommended by the Food and Drug Administration appears safer, he said.

Researchers from Brigham and Women's Hospital and Harvard Medical School; Tufts Medical Center; the University of Erlangen-Nuremburg, Germany; the Faculdade de Medicina de São José do Rio Prieto, Brazil; University Medical Center, Groningen, the Netherlands; Northwestern University Feinberg School of Medicine; Health Sciences Centre, St. John's, Canada; Mario Negri Institute for Pharmacologic Research, Italy; Amgen; and the University of Glasgow also participated in the study.
For more info- http://www.sciencedaily.com/releases/2010/12/101229124246.htm

Age Could Affect How Well Cancer Patients Cope

Even though they have a better chance of survival, younger adult cancer patients have more difficulty coping with the pain and emotional and financial issues of cancer than older patients, researchers say.

Compared with cancer patients in their 50s and 60s, adult patients aged 40 and younger reported more flare-ups of pain, and more trouble thinking quickly and logically six months after their diagnosis, said the University of Michigan Health System researchers.

The study included 100 patients with advanced breast, lung, colorectal or prostate cancer, or the bone marrow cancer multiple myeloma, who were surveyed six months after diagnosis.

The younger patients experienced pain in more locations throughout their bodies than older patients (4.5 locations vs. 2.2 locations), with older adults mostly experiencing spinal pain and younger patients having pain in the spine, back, arms, abdomen and elsewhere, according to the report.


The researchers found that 75 percent of younger patients had trouble paying health-care bills, twice the rate among older patients. In general, younger patients reported smaller incomes.

The study, published in the November issue of Pain Medicine, also noted that 8 percent of patients aged 40 and younger said pain affected their mood, compared with 4.35 percent of patients aged 41 to 59 and 4.14 percent of patients 60 and older.

"Our study provides evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike, but demonstrate an increased toll for younger adults, especially financially," study author Dr. Carmen R. Green, a professor of anesthesiology, obstetrics and gynecology, and health management and policy, said in a university news release.
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Vitamin D Tied to Cardiovascular Risk Factors, Disease

Researchers combing a large database have found evidence to suggest that vitamin D levels play a highly significant role in cardiovascular health, according to an article published in the Oct. 1 issue of the American Journal of Cardiology.

Jeffrey L. Anderson, M.D., of the Intermountain Medical Center in Murray, Utah, and colleagues analyzed 41,504 patient records with at least one measured vitamin D level to determine the prevalence of vitamin D deficiency and how that relates to cardiovascular risk factors, disease, and mortality.

The researchers found a 63.6 percent prevalence of vitamin D deficiency, which was associated with highly significant increases in diabetes, hypertension, hyperlipidemia, and peripheral vascular disease. Levels of vitamin D were also found to be strongly associated with coronary artery disease, myocardial infarction, heart failure, stroke, and mortality.

In conclusion, we have confirmed a high prevalence of vitamin D deficiency in the general health care population and an association between vitamin D levels and prevalent and incident cardiovascular risk factors and outcomes. These observations lend strong support to the hypothesis that vitamin D might play a primary role in cardiovascular risk factors and disease. Given the ease of vitamin D measurement and replacement, prospective studies of vitamin D supplementation to prevent and treat cardiovascular disease are urgently needed.

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Stop Smoking' Ads That Target Emotions Seem to Work Best

Television ads that encourage people to quit smoking are most effective when they use a "why to quit" strategy that includes either graphic images or personal testimonials, a new study suggests.

The three most common broad themes used in smoking cessation campaigns are why to quit, how to quit and anti-tobacco industry, according to scientists at RTI International, a research institute.

The study authors examined how smokers responded to and reacted to TV ads with different themes. They also looked at the impact that certain characteristics -- such as cigarette consumption, desire to quit, and past quit attempts -- had on smokers' responses to the different types of ads.

"While there is considerable variation in the specific execution of these broad themes, ads using the 'why to quit' strategy with graphic images or personal testimonials that evoke specific emotional responses were perceived as more effective than the other ad categories," lead author Kevin Davis, a senior research health economist in RTI's Public Health Policy Research Program, said in an institute news release.

Davis and his colleagues also found that those who had less desire to quit and those who had not tried quitting in the past year had significantly less favorable responses to all types of smoking cessation ads. The same was true, to a lesser extent, for smokers with high levels of cigarette consumption.

"These findings suggest that smokers clearly differ in their reactions to cessation-focused advertising based on their individual desire to quit, prior experience with quit attempts and, to a lesser degree, cigarette consumption. These are important considerations for campaign creators, designers and media planners," Davis said.

The study, published online in the journal Tobacco Control, used data from 7,060 adult smokers in New York State who took part in an online survey.

On Wednesday, the U.S. Food and Drug Administration announced a new "comprehensive tobacco control strategy" that would include not only graphic photos on packs of cigarettes, but bold statements such as "Smoking Will Kill You."

The proposed photos would include depictions of emaciated lung cancer patients, a dead body in a morgue, a baby confined to a respirator (presumably the result of secondhand smoke), and other consequences of smoking.
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