Am Fam Physician. 1999;60(1):251-252
Women Under Age 75 Have a Higher Mortality Rate After MI Than Men
(48th Annual Scientific Session of the American College of Cardiology) Women have a higher short-term mortality rate after myocardial infarction than men, but only when the myocardial infarction occurs before the age of 75 years. This is the conclusion of an analysis of data from 384,878 patients enrolled in the National Registry of Myocardial Infarction from June 1994 through January 1998. Both before and after adjustment for medical history, admission data, type of treatment, time to hospital arrival and hospital characteristics, the risk of hospital mortality was higher in women than in men up to the age of 75 years. In the adjusted data, the risk of death in women increased 7 percent for every five years of younger age. In the analysis, the adjusted odds ranged from 1.74 in women aged 50 years and younger to 0.91 in those aged 85 to 89 years. The investigators believe that younger women who have had a myocardial infarction are in a high-risk group deserving special study.—viola vaccarino, m.d., et al., Yale University School of Medicine, New Haven, Connecticut.
Early Intervention Reduces Mortality in Elderly Persons After MI
(American College of Cardiology) Timely application of ABC (aspirin, beta blocker, clot buster [or thrombolytic] therapy) reduces mortality in elderly patients who present to the emergency department with myocardial infarction, according to an evaluation of patients receiving Medicare who had a myocardial infarction during an eight-month period in 1994. The initial project involved 220,000 cases of acute myocardial infarction nationally and 16,000 in New York state. Ten quality indicators established by the American College of Cardiology and the Health Care Financing Administration were measured. Remeasurement of 8,000 patients was done during four months in 1996. The investigators found decreased mortality in patients who were treated according to the ABC guideline: aspirin within 24 hours of myocardial infarction (achieved in 55 percent of the patients); beta blockers within 12 hours (achieved in 39 percent of patients) and thrombolytic therapy within 60 to 90 minutes of arrival in the emergency department (achieved in 26 percent of patients). The investigators believe that prompt intervention in elderly patients with myocardial infarction will decrease mortality rates in such patients.—monte malach, m.d., et al., Lake Success, New York.
Test Can Predict Development of Coronary Disease in Women
(71st American Heart Association Scientific Sessions) Electronic beam computed tomography (EBCT) performed before menopause is effective in predicting development of disease in the coronary arteries and aorta after menopause, according to a 15-year study of 541 women. The study was started in 1983 and included premenopausal women with an average age of 48 years. Levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were measured at baseline. Caloric intake and fat as a percentage of total calories, blood samples and physical activity were also monitored. Biologic and behavioral characteristics were evaluated as the women went from premenopause to post-menopause. Of the 541 women, 168 later underwent EBCT to measure calcification of the heart and aorta. About 50 percent of the women were receiving hormone replacement therapy, and 79 percent of these were receiving estrogen and progesterone. High LDL levels were a powerful predictor of the extent of coronary and aortic calcification, and high HDL levels predicted immunity to developing significant coronary or aortic coronary calcification. In combination with high LDL levels, cigarette smoking was a powerful predictor of aortic and coronary calcification. Women with high LDL levels and low HDL levels were at high risk of having high calcium scores, compared with those with low LDL levels and high HDL levels. The investigators believe that use of EBCT will more accurately identify women who are at high risk of coronary disease and who may benefit from early interventions.—lewis kuller, m.d., dr. p.h., Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa.
Use of Rofecoxib Improves Quality of Life in Osteoarthritis Patients
(62nd National Scientific Meeting of the American College of Rheumatology) A randomized, double-blind study of 672 patients with osteoarthritis of the hip or knee has shown that rofecoxib (Vioxx), one of a new class of treatments for arthritis called cyclooxygenase-2 (COX-2) specific inhibitors, is effective in relieving the pain and inflammation of osteoarthritis. COX-2 inhibitors are thought to be gentler on the stomach than other arthritis treatments while providing effective pain relief. In the study, patients receiving rofecoxib reported significant improvement in physical functioning, compared with patients receiving placebo. Physical functioning included decreased pain and an improved ability to perform daily activities, such as climbing stairs and bending over. The patients also reported that their improved physical health directly resulted in a significant improvement in their mental well-being. Rofecoxib works by inhibiting COX-2 without significantly inhibiting COX-1, which is an enzyme responsible for protecting the lining of the stomach. COX-2 is responsible for producing prostaglandins that cause pain and inflammation.—thomas schnitzer, m.d., ph.d., et al., Northwestern University, Chicago, Illinois.
HRT May Help Prevent Onset of Parkinson's Disease in Women
(Fifth International Congress of Parkinson's Disease and Movement Disorders) Postmenopausal women receiving hormone replacement therapy (HRT) may be less likely to develop Parkinson's disease than those who do not receive HRT, according to a study of 72 women with Parkinson's disease and 72 age-matched subjects without Parkinson's disease. The subjects ranged in age from 30 to 56 years and were identified through an epidemiology records linkage system. Parkinson's disease was less common in the women receiving HRT than in those who did not receive HRT. Six (8 percent) of the women with Parkinson's disease had been receiving HRT for six months or more, compared with 10 (14 percent) of the women without Parkinson's disease. The women with Parkinson's disease were also three times more likely to have had hysterectomies than women without the disorder, suggesting that the loss of naturally occurring estrogen is a risk factor in Parkinson's disease. The investigators believe that these findings about the role of estrogen in Parkinson's disease may explain why men have a higher risk of Parkinson's disease than women. They suggest that a larger, multicenter study be conducted on the subject.—demetrius m. maraganore, m.d., et al., Mayo Clinic and Mayo Foundation, Rochester, Minnesota.