Page 8 —Thursday, October 24, 2002 HEALTH Oiasctic Study: Aspirin aids after bypass By LINDA A. JOHNSON Associated Press Writer A groundbreaking study has disproved doctors' long-held worries that giving aspirin to heart patients right after bypass surgery can trigger disastrous bleeding, a finding that could save thousands of lives every year. The study, published in today's New England Journal of Medicine, found the use of aspirin dramatically lowers the risk of death and complications, and keeping patients on the blood-thinning pill before the surgery also improved outcomes. Researchers at the Ischemia Research & Education Foundation and other experts said the results — from 5,065 patients at 70 medical centers in 17 countries — should quickly change how doctors handle the 1 million patients worldwide who undergo coronary bypass surgery each year. Foundation researchers estimate giving a 5-cent aspirin within hours of bypass surgery could prevent about 27,000 deaths and 51,000 serious complications annually worldwide. That would also save billions of dollars, given the lower complication rate and shorter hospital stays. "The results are so strikingly positive and so definitive," said Dr. Robert Bonow, president of the American Heart Association. "It's studies like this that actually change practice." Aspirin has been a mainstay of treating and preventing heart disease for a generation because it thins the blood and prevents clots. Yet many doctors are reluctant to give it soon after or shortly before bypass, fearing it will interfere with clotting and cause life-threatening internal bleeding. In the study, about 60 percent of the patients received aspirin in doses up to 650 milligrams. Those getting aspirin within 48 hours of bypass surgery were only one-third as likely to die in the hospital as the others. The aspirin group also was only half as likely to suffer a heart attack or stroke while still in the hospital, only one-fourth as likely to suffer kidney failure and about one-third as likely to have bowel damage from blood clots. Aspirin helps after bypass surgery Giving aspirin to heart patients soon after bypass surgery dramatically lowers the risk of death and complications, a new study shows. It helps to thin blood and prevent clotting. Thick elastic wall Normal coronary artery Blood is able to pass through unhindered. Diseased coronary arteries Estrogen-like drug builds bone without side effects Plaque buildup inside the artery decreases ability for blood to flow through the _ _ arteries. Aspirin thins blood, reducing the possibility for a blood clot and decreases the ability of platelets to block arteries narrowed by accumulated plaque. Outcome of the study Fatal and nonfatal outcomes among patients who received aspirin within the first 48 hours and patients who did not. 12 percent --• 10 8 ••-•6 I I With aspirin !• No aspirin By PAUL RECER AP Science Writer WASHINGTON — Researchers have found a compound that works like estrogen to prevent brittle bone disease in mice, but with none of the hormone's side effects. The discovery may offer an alternative to older women who have stopped hormone replacement therapy because of the risks of cancer and heart disease. Experiments found that the synthetic compound, called estren, increased bone density and strength in mice that had been surgically altered to mimic menopause, but the chemical had none of the dangerous side effects of estrogen. "This seems to be superior to estrogen in its effect on the bone, but it has no effect on the sex organs," said Dr. Stavros C. Manolagas, a researcher at the University of Arkansas for Medical Sciences and the Central Arkansas Veterans Health Care System. Experts on osteoporosis, the brittle bone disease, said if estren is found to work as well in humans it could substitute for the hormone replacement therapy, or HRT, that has been used to maintain bone health in women after menopause. An estimated 20 million American women were regularly taking hormone supplements to treat postmenopausal symptoms, including hot flashes and the thinning of the bones. But in July, federal scientists abruptly ended a study of the combination of estrogen and progestin, after finding evidence that long-term use increased the risk of breast cancer, strokes and heart attacks. Sales of various formulations of HRT have dropped 15 percent to 40 percent since then. Jill L. Carrington of the National Institute on Aging, part of the National Institutes of Health, said Manolagas' research is important because he has demonstrated there are compounds that can safely replace estrogen hormone therapy for treating the loss of bone density. "This opens up a new direction for how to treat osteoporosis with drugs that can be designed to take advantage of the best effect of estrogen widiout adding some of the harmful effects," said Carrington. "It also opens up the possibility of finding new avenues of treatment of men with osteoporosis." Federal health officials estimate that 10 million people have been diagnosed with osteoporosis and another 34 million — 55 percent of those over 50 years of age — are at high risk of the disorder gradually thinning their bones. Eighty percent of osteoporosis patients are women. As people age and .the sex hormones estrogen and testosterone decline, bones become porous and brittle. Eventually, an ordinary bump or strain can causes bones to break, particularly in the spine and hip. Officials estimate that there are about 1.5 million fractures annually among osteoporosis patients, leading to medical costs of about $17 billion in 2001. In the new study, Manolagas and his colleagues screened a number of compounds to find one, which they called estren, that activated the bone-building action of estrogen without affecting cells in the sex organs or breasts. 4 -... M I Death from any cause Myocardial infarction Congestive heart failure Stroke Renal failure Scientists try to ease confusion over who should take hormones SOURCE: The New England Journal of Medicine N. Rapp. C. New/AP "If my mother were going into surgery now, there's no question she would get aspirin postoperatively," said the lead researcher, Dr. Dennis Mangano, founder of the ischemia foundation, a nonprofit research group in San Francisco. The study was conducted from 1996 through 2001. The heart association and the American College of Cardiology in 1999 recommended giving patients 100 mg to 325 mg of aspirin within 24 hours of bypasses using grafts from leg veins. The guidelines do not cover grafts using chest arteries or both veins and arteries, but Mangano said that in the study, aspirin benefited patients getting even' graft type. In another surprise, the study also found patients who stopped taking aspirin before surgery were more likely to die than those" who kept on taking it. That, too, goes against the conventional wisdom; in fact, American Heart Association guidelines call for taking many heart patients off aspirin 7 to 10 days before bypass surgery. Dr. Daniel Shindler, associate professor of medicine and anesthesiology at Robert Wood Johnson Medical School in New Brunswick, N.J., said the new study could change that practice, too. "This paper allays the fear of giving aspirin preoperatively," he said. Cardiac bypass surgery is becoming more common as the world's population gets older and heavier. Despite improved surgical techniques, major complications hover around 15 percent. Patients in the study were not randomly chosen for each treatment, as is done in many experiments; the doctors decided who got aspirin, which could have influenced results. But Mangano said that limitation is far outweighed by the uniform findings and the comprehensive data on each patient. By LAURAN NEERGAARD AP Medical Writer BETHESDA, Md. — Women have quit hormone therapy in droves since a major study in July declared the pills far riskier than once thought — but federal scientists seeking to ease confusion over just who should ever take post-menopausal hormones acknowledge they have lots of questions still to answer. One clear recommendation, scientists told a meeting at the National Institutes of Health on Wednesday, is that women shouldn't start hormone therapy in hopes of preventing age- related diseases — one big reason that estrogen-progestin pills were prescribed to some 6 million U.S. women. "We can't take a pill for the rest of our life to make us young again. Dis- f EMERSON SQUARE appointing but true," said Dr. Susan Hendrix of Wayne State University, a co-investigator in the NIH's Women's Health Initiative, the biggest study ever done of hormone therapy. Still, hormones are the mainstay treatment for hot flashes and other menopause symptoms — and there lie the biggest quandaries: Which women are at such high risk from the pills' side effects that they shouldn't use them even to briefly ease menopause symptoms? And for women who do try the pills to ease hot flashes, how long are they safe to use? Nobody yet knows. But Hendrix offered herself as an example, saying her own hot flashes aren't bad enough for her to risk talcing hormones, but that she might reconsider if they were especially severe. "There's still a place for this product," said Dr. Ginger Constantine of Wyeth Pharmaceuticals, maker of the best-selling hormone brands. She noted that lower doses than were used in the Women's Health Initiative study can bring menopause relief — although there's no proof they'll also bring fewer side effects. The study that set off the controversy found women who take the es- trogen-and-progestin combination are at significantly higher risk of heart disease and cancer than previously thought. For every 10,000 women taking the pills, every year there will be eight more breast cancers, seven more heart attacks, eight more strokes and eight more life- threatening blood clots in the lungs than if they hadn't taken the pills, the study found. For an individual, those are small risks — although with millions of users they add up. Worm study sheds light on aging By The Associated Press A tiny worm that barely lives more than a week under normal conditions may hold clues that could help keep us stronger and healthier until old age finally catches up with us, researchers say. C. elegans — a roundworm that has already been the subject of research that won a Nobel Prize this year — ap- parendy goes to seed much like middle-aged people, losing muscle cells in a process called sarcopenia, according to a study by Rutgers biologist Monica Driscoll. The soil-dwelling, bacteria- eating worms have a very simple structure that allows scientists to count and observe each cell from birth to death. The worms also can be raised under experimental conditions that produce nearly identical populations. SOPHIA CALVETTI has a birthday on October 27™. Stop in at Emerson Square to Wish her a HAPPY BIRTHDAY! PATRONS' MUTUAL FIRE INSURANCE CO. 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