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March 2000

Depression Linked To Low Cholesterol
March 25, 2000

Results of a study conducted by Dutch researchers provide additional evidence for a link between low cholesterol levels and an increased risk of depression in men.

Dr. Diederick Grobbee of University Medical Center in Utrecht, the Netherlands, and colleagues "measured serum cholesterol levels in some 30,000 men, as part of a large screening program," he told Reuters Health. Because of earlier work that seemed to indicate an association between low cholesterol levels and a heightened risk of suicide, the investigators used this screening data to "select men with persistent low serum cholesterol (levels)," Grobbee said.

"We compared the presence of depressive symptoms, anger, hostility, and impulsivity in these men, to men with cholesterol levels in the normal range," he explained.

According to the study in the journal Psychosomatic Medicine, the researchers found that "men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms."

While his team's result could be seen as a "challenge" to the view that 'the lower the cholesterol, the better,' and his findings "may have implications (in terms of) guidelines regarding target levels of subjects treated (for high cholesterol)," Grobbee noted that, "in general, patients... treated with cholesterol-lowering drugs... do not reach levels in this range."

He added that "the impact of elevated cholesterol on heart disease... is much larger than the impact of low cholesterol on depression and violent death," cautioning that these findings ought not be used "as an argument against treatment of patients with high cholesterol levels."

What these findings may help do, however, is "shed light on mechanisms that may cause depression and affect mood," the researcher said. Grobbee, who is the chair of the Julius Center for Patient-Oriented Research at the medical center, believes that cholesterol may affect the metabolism of serotonin, a substance known to be involved in the regulation of mood. He and his colleagues have previously shown that serotonin levels are also reduced in men with low levels of cholesterol.

Though the current study results are provocative, Grobbee cautions that "it remains possible that serum cholesterol changed in response to depressive symptoms, rather than the other way around. So the next step would be to confirm our findings in a prospective study" designed to follow a large group of people who are healthy at study onset to see when they develop disease symptoms.

SOURCE: Psychosomatic Medicine 2000;62.

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Many Community Wells Threatened By Gas Additive
March 24, 2000

A chemical added to gasoline to reduce air pollution may be a threat to the water supply, according to results of a new study. Researchers estimate that thousands of community water wells located near leaky underground storage tanks are at risk of being contaminated by the additive, methyl tert-butyl ether (MTBE).

Since 1990, when Congress amended the Clean Air Act to require states to reduce levels of carbon monoxide and ozone in the air, the use of MTBE, which makes gasoline burn more cleanly, has increased substantially. The chemical may be good for the air, but even tiny amounts of MTBE can give water a foul taste and smell.

"A significant but currently unknown number of community water wells may be at risk, and the risk of contamination, even if MTBE were to be removed today from gasoline, will continue for at least the next decade," one of the study's authors, Dr. John Zogorski of the US Geological Survey in Rapid City, South Dakota, told Reuters Health.

According to Zogorski and his colleagues, when even a small amount of gasoline leaks from a pipeline or an underground fuel tank, MTBE can make its way over long distances to contaminate water wells. In one case, gasoline spilled during a single automobile accident led to the contamination of 20 nearby wells with MTBE. In the interview, Zogorski said that this case was unusual, but MTBE is a threat to many wells since it can remain in ground water for years and can travel considerable distances underground.

The extent of MTBE contamination is uncertain. But in a report based on data from 31 states, Zogorski and colleagues estimate that about 35% of community water wells — about 9,000 wells — are located within a 1-kilometer radius of a leaking underground storage tank. Even though not all of these tanks are leaking gasoline containing MTBE, close to two-thirds may be leaking MTBE, the researchers note in their report, which will be published in the May 1st issue of the journal Environmental Science and Technology. The article is being released early on the website of the American Chemical Society at http://www.acs.org.

In the analysis, the investigators took into account the rate at which water is pumped from a well. According to Zogorski, speeding up the pumping rate to draw more water from a well can increase the amount of MTBE drawn from ground water into the well.

Currently, California plans to ban MTBE in gasoline beginning in 2003 and Maine has received the go-ahead from the Environmental Protection Agency to ban the additive, provided that it puts in place other measures to meet air quality standards. In addition, New Jersey has federal permission to limit the use of MTBE in gasoline during the winter.

But Zogorski said that finding alternative formulations of gasoline that reduce air pollution without posing a threat to the water supply won't be easy. Before another additive is selected, its effects on the environment should be thoroughly studied, so as "not to make the same mistake twice," he said.

The current report only covers water that comes from wells, but Zogorski said that a study of MTBE in water from all sources, including lakes, rivers and reservoirs, is underway.

SOURCE: Environmental Science and Technology May 1, 2000.

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ACE (angiotensin-converting enzyme) Inhibitors Help to Prevent Heart Attacks After Angioplasty
March 24, 2000

When it comes to preventing heart attacks, people with the crushing chest pain known as angina may benefit from taking an ACE inhibitor drug in addition to having angioplasty, researchers report.

Typically, angina patients have one treatment or the other — but not both, according to a report in the March 15th issue of Journal of the American College of Cardiology.

ACE (angiotensin-converting enzyme) inhibitors are drugs that widen blood vessels, increasing blood supply to the heart, and angioplasty is an artery-clearing procedure in which a balloon-tipped catheter is threaded into a blocked artery and inflated, flattening fatty plaques against the artery wall.

While angioplasty helps many people with angina, those who also have a poorly functioning left ventricle, the major pumping chamber of the heart, do not tend to do as well.

In a new study, 159 people with angina and a moderately dysfunctional left ventricle underwent angioplasty to restore blood flow to the heart. Afterwards, participants took either the ACE inhibitor ramipril or a ('dummy') placebo pill each day, according to a team of researchers led by Dr. Lars Kjoller-Hansen, of the Rigshospitalet in Copenhagen, Denmark.

After an average of nearly 3 years, treatment with ACE inhibitors did not significantly reduce the risk of chest pain compared with the placebo. However, the risk of dying a cardiac-related death was lower in those taking ramipril.

Overall, one patient taking ramipril died a heart-related death during the study compared with seven patients taking a placebo, according to the study, which was funded in part by the AstaZeneca pharmaceutical company.

Based on the results, the researchers recommend that people with angina and a moderately dysfunctional left ventricle be considered for long-term treatment with ACE inhibitors after surgery. An expert not involved in the research agreed that more people might benefit from the drugs than are currently taking them.

"This was a small study, but the results are certainly consistent with those of larger studies," Dr. Bertram Pitt, of the University of Michigan School of Medicine in Ann Arbor, said in a statement issued by the journal. "The results suggest that everybody with coronary artery disease should probably be on an ACE inhibitor such as ramipril."

SOURCE: Journal of the American College of Cardiology 2000;35:881-888.

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Alcohol's Effect On Memory Revealed
March 23, 2000

Alcohol's ability to interfere with memory is well known. People who drink to excess often can't remember details of the previous night's revelry or may suffer complete memory blackouts of the events.

Scientists now think they understand how it happens, and the discovery may point to ways to curtail the memory and learning problems faced by children born with fetal alcohol syndrome caused when women drink during pregnancy.

Researchers at Harvard Medical School in Boston discovered that alcohol disrupts the ability of cells to stick together. Britain's Electronic Telegraph explains that this interferes with the ability of the brain to create the links and networks needed to store memory.

This effect could be particularly pronounced in women. University of North Carolina researchers report that women succumb to alcohol's effects faster because their own sex hormones trigger a brain chemical called allopregnanolone, the BBC News reports. The U.S. National Institute on Alcohol Abuse and Alcoholism explores the consequences of alcohol abuse in women in more detail.

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Study Disproves Myths About Herpes
March 23, 2000

People infected with genital herpes can spread it even between flare-ups, when they have no symptoms, new research suggests.

Previously, patients and even most doctors thought people with herpes were unlikely to be infectious when they had no symptoms, which can include painful, oozing blisters, ulcers and fissures and tingling and burning.

In a study disapproving several myths about the incurable, widespread virus, University of Washington researchers found the virus present in genital secretions even when patients didn't notice any symptoms.

"The message from this study is first to encourage people who might be at risk for genital herpes to be tested and, No. 2, they should abstain during outbreaks and use condoms at all other times," said Dr. Anna Wald, an assistant professor in the department of medicine and epidemiology.

The study was reported in Thursday's New England Journal of Medicine.

Genital herpes, usually caused by the herpes simplex virus type 2, lurks in about one-fourth of U.S. adults, although only an estimated 20 percent of them know it.

Herpes is spread through sexual contact when it enters the body through tiny passages in the skin. The virus lies dormant in nerves at the base of the spinal cord until something triggers an outbreak. Flare-ups generally last for a few days.

There is no cure, but drugs can reduce the severity and frequency of flare-ups.

While herpes isn't fatal, the sores can make it easier to be infected by AIDS. Without precautions, it can be transmitted during childbirth, infecting the baby and sometimes causing brain damage or death.

Wald's team studied 53 men and women who were unaware they had the virus until it was spotted in a blood test on a routine visit to a medical clinic in Seattle. Those patients were then asked to participate in the study, along with another 90 clinic patients with a history of symptoms.

Each swabbed specimens from around the anus and genitals daily for three months and kept a diary of symptoms.

But both groups had the virus present in secretions at the same rate on symptom-free days: about 3 percent, or one day a month on average.

The researchers also found that men were potentially infectious at the same rate as women when no symptoms were noticeable, disproving the myth men can't spread the virus while symptom-free.

Dr. Judith Wasserheit, head of sexually transmitted disease prevention at the Centers for Disease Control and Prevention, said the study confirms other research but brings some good news: "It is possible to learn how to recognize many of your symptoms and to use that knowledge to help protect your partner."

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Male Menopause — Fact Or Fiction?
March 24, 2000

Do men experience a ''change of life'' in middle age — a hormonal shift equivalent to menopause in women? Debate over the concept of ``male menopause'' continues to illicit widely divergent viewpoints, as evidenced by two opposing arguments made by British researchers published as a ``For and Against'' editorial in the March 25th issue of the British Medical Journal.

Presenting evidence for the existence of significant hormonal changes in men, Duncan C. Gould and a colleague from Goldcross Medical Services in London, UK, highlighted the fact that concentrations of testosterone decrease by up to 50% in men between the ages of 25 and 75.

In addition, the authors note that 50% of men over age 50 have abnormally low levels of testosterone due to changes in their endocrine (hormone) systems. The researchers point out that this steady decline often manifests itself in symptoms that are similar to those observed in menopausal women: hot flashes, sweats, depression, nervousness, fatigue, and an overall drop in energy.

The team also notes the association between aging and an increase in body fat in men, which they suggest may be attributable to a drop in growth hormone concentrations.

However, while Gould and his colleague argue ``for'' the medical acceptance of a male equivalent of menopause, they suggest that the term ``male menopause'' may be a misleading choice of words in that the overall male hormonal decline is gradual and linear and occurs in only some men, while for women, the hormonal drop experience is universal and sudden. The authors suggest the term ``andropause'' may be a more accurate label to describe the male experience.

Professor Howard S. Jacobs, on the other hand, makes the case that regardless of what it is called, there is no valid conceptual equivalent of menopause among men. Jacobs — of the Royal Free and University College School of Medicine at Middlesex Hospital in London — argues that the gradual nature of the changes in testosterone levels among aging males is a fundamentally different experience than the fast depletion of estrogen levels among menopausal women.

Jacobs suggests that treating men with testosterone hormonal supplementation in a manner similar to the estrogen supplementation commonly given to menopausal women does not achieve comparable results — citing studies that have shown that among men there is no significant increase in bone mineral density levels or muscle strength after such treatment.

Deducing that if similar treatment methods are not similarly effective then the medical conditions are not similar to begin with, Jacobs concludes that the hormonal and biological changes in aging men — exemplified by testicular failure and a decline in muscle and bone mass — are simply functions of growing old rather than ``male menopause.''

As further proof of a striking difference between the male and female condition and treatment scenario, Jacobs also notes that the development of the popular nonhormonal prescription drug Viagra has successfully addressed the issue of erectile dysfunction that affects 50% of men between the ages of 50 and 70 — and has done so in a much more effective manner than hormonal treatment has traditionally been able to achieve.

In interviews with Reuters Health, both Gould and Jacobs expressed confidence that their arguments are sound and sensible. Gould emphasized that while ``male menopause'' is a ''silly term'' that can and does lead to confusion, it nonetheless reflects a real set of hormonal changes that affect 1 out of every 2 males. ``In men,'' he said, ``there's a gradual decline from the age 35 to 40 in testosterone levels, and in some men the drop is noticeable quickly because they start with relatively low levels of testosterone, while some men... will start with very high levels.''

Gould added that by acknowledging this set of facts and giving the condition a name, the medical community is simply allowing for proper diagnosis and appropriate treatment. ``If you diagnose someone with low testosterone levels, you give them testosterone treatment according to the World Health Organization guidelines,'' he stated.

On the other hand, Jacobs countered plainly that the notion is without medical support. ``I think the people that are talking about it are in a kind of 'time warp,''' he said. ``The 'male menopause' notion was put together before the invention of Viagra. They haven't quite realized that it's Viagra — a nonhormonal remedy — which is what cures the impotence of the elderly rather than hormone treatment. And Viagra's a pretty safe drug.''

Jacobs summed up his take on the debate by stating that ''the proposed notion of 'male menopause' just has no support in endocrinology.... And the people that are talking about it certainly haven't bothered to follow-up the modern medical literature.''

SOURCE: British Medical Journal 2000;320:858-861.

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Domineering, Irritable People At Risk For Heart Disease
March 24, 2000

Men who interrupt others in the middle of sentence — as well as those that feel a flash of irritation when they are interrupted — may be at higher risk of heart disease, results of a study suggest.

Having a dominant personality (one sign being a tendency to interrupt others) or a high level of irritability are two personality traits that make one prone to heart problems, researchers report.

"Both of these types are very much at risk of heart disease," said Dr. Aron Wolfe Siegman, a psychologist at the University of Maryland in Baltimore County, and lead author of a study in Psychosomatic Medicine.

The findings are from a study of 101 men and 95 women, including 44 people with definite heart disease and 99 without heart disease. The study subjects were interviewed when they went for an exercise stress test, which measures blood flow through the heart.

People who were rated as having a dominant personality had a 47% higher risk of heart disease, and those who had high scores of irritability had a 27% increase in heart disease risk compared with their less domineering, more easygoing counterparts.

What's more, the researchers found that the study did not support the common belief that men display their anger and women keep it in. Men and women may just express their anger differently, according to the report.

An increased heart disease risk is seen in women who have more indirect displays of anger, such as antagonistic behavior, while a man's heart risk is higher if he tends toward full-blown outward expressions of ire, the authors note.

In women, there was a correlation between heart disease and covert displays of their anger, such as wearing angry expressions or making cutting remarks. Men were more likely to suffer heart disease if they displayed dominance, such as constantly talking over others or interrupting conversations, the investigators found. Both sexes were at risk for heart disease if they were constantly irritable.

"The relationship between emotions and disease are mediated through the body," Siegman explained. Being angry and exploding or making cutting remarks increases blood pressure, causing heart damage, he said.

A subset of 97 patients had their anger levels rated by their spouses. Women's ratings of their spouses' anger-out levels corresponded with their husbands' coronary heart disease.

The same was not true for the men's ratings of their wives' displays of anger. This shows that women do not suffer heart disease related to acting out in anger as is the case with men, the researchers conclude.

"Anger should not be held in or kept in subtle ways," Siegman warned. "Anger should be discussed. You should confront the person with whom you are angry but in a controlled fashion."

SOURCE: Psychosomatic Medicine 2000;62.

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US Schoolchildren Lack Daily Exercise
March 23, 2000

Many US schools no longer offer daily physical education, despite the fact that the vast majority of parents want such programs for their youngsters in elementary, middle or high school, according to results of a new survey.

"Unfortunately, most school districts across the nation are not living up to parental expectations or public health requirements," said Carl Gabbard, president of the National Association for Sport and Physical Education, which sponsored the survey. "Indeed," Gabbard said, "5% of children receive no physical education at all."

In the survey, more than 1,000 US adults 18 years of age and over and 500 teens aged 12 to 17 were interviewed. The investigators found that even though 81% of parents of school-age children said they wanted their children to receive daily physical education at school, just 44% of youngsters actually engaged in school-based physical activity on a daily basis.

The findings were released Tuesday as part of the annual convention of the American Alliance for Health, Physical Education, Recreation and Dance, in Orlando, Florida.

US Surgeon General Dr. David Satcher said he is "alarmed by the trend we have seen over the last 20 years of decreasing physical education requirements in public schools across the country. As a nation, we are becoming increasingly less active in our lifestyles — at home, at school and at work."

There seems to be an 'opinion gap' between adults and their children when it comes to the reasons why youngsters are not getting enough exercise.

According to Gabbard, parents "believe their kids lack interest, do not have enough time or spend too much time watching television (57%) or playing computer games (59%). Their children, on the other hand, say they do not have the time (24%), spend too much time doing homework (19%) or lack interest (13%)." Most parents say they place limits on the amount of time they allow their children to engage in 'couch potato' pursuits such as watching TV or playing video games, according to the survey.

"Prevention is the key to the future," Satcher said. "We must learn how to prevent obesity and promote healthy lifestyles. Our schools have a responsibility to educate both minds and bodies."

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Even a Little Bit of Exercise Helps A Lot
March 23, 2000

The public is constantly reminded that exercise is important for staying healthy, but if you look at those ads for exercise equipment or health clubs, you might think that the goal is to look like an Olympic contender.

Rest easy. The statistics reveal that there's only a slight difference in overall longevity between those who are exceptionally fit and people who choose much more modest fitness plans, such as a daily walk. A much bigger difference does exist for the genuinely unfit, such as those who can't walk down the block without getting winded, the Electronic Telegraph reports.

Walking provides a fine way to achieve added fitness that will help you to live longer, even if you don't end up looking like the buffed models who pose for health club ads. More than 20 minutes of walking each day lowers your risk of high blood pressure by a third and two miles daily knocks your risk of a heart attack in half.

A Detroit News feature provides a helpful list of simple everyday activities that improve fitness along with the number of calories burned by each. For example, cooking or preparing food and pushing a child in a stroller all burn 176 calories per hour, while general gardening eats up 352, and mowing the lawn takes 387.

And if you're just looking for peace of mind, researchers at Hull University in England report that strenuous exercise isn't needed for a healthy psyche. A survey found that people who performed enjoyable, albeit sedentary, activities such as chess or watching television, felt as good as those who worked out. The Times of London has the details.

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