Men better than women at assessing heart attack risk

Most people know that your family's medical history is an important part of your own medical history. It helps you to understand what kinds of health problems you may be more likely to acquire, based on your genetic make-up.

A new study, however, suggests that young women with a family history of heart attack are less likely to understand their risk for heart disease and more likely to make poor lifestyle choices that increase their risk. Researchers analyzed data from nearly 2,500 men and women ages 30-50 who participated in the Dallas Heart Study and who had a family history of premature heart attacks. They defined family as a first degree relative (i.e., mother, father) and "premature" as a male family member who had a heart attack before age 50 and a female family member who had a heart attack before age 55.

They found that compared to women with no family history of heart attack, having such a family history was linked to having 2 or more traditional risk factors for heart disease (i.e., high cholesterol, high blood pressure, diabetes, and smoking). The investigators did not find this association for men. They also found that women with a family history of heart attack were more likely to have coronary artery calcification, or buildup in the walls of the arteries in the heart. This build-up matched that for men without a family history of heart attack. Women with a family history of heart attack also were less likely to make healthy lifestyle choices. They smoked more and exercised less than men with the same family risk. Finally, fewer women with a family history of heart attack perceived their risk of heart attack to be as high as men with the same family history.

These findings are not surprising, but they are concerning. Men typically have been the focus of research and education on heart disease. Consequently, women may underestimate their actual risk, despite their family histories. Yet this is a dangerous precedent, as heart disease is the number one cause of death for women just as it is for men.

If you are among the women with a family history of heart disease, know the risk factors, including which ones you can control. Then make those healthy lifestyle choices - stop smoking, eat less fat, move your body, and limit stress. This is not just a men's disease, and you can be affected.

Even OBs don't always know when they're in labor

My colleague, Dr. Wendy Hansen, is featured on Parents.com this week. She is an OB/GYN and division chief for maternal-fetal medicine at the University of Kentucky. She discusses how when she was pregnant, she wasn't sure whether she was going into labor - despite having delivered over 600 women before she herself gave birth to her first set of twins (she has two sets who are 15 months apart - whew!).

This should make you feel pretty good about calling your doctor or midwife at 2AM when you think you might be having contractions, but you're not sure, and your husband says wait until the morning, but your back is hurting, and it could be back labor, and you are 35+ weeks, and there's definitely something going on in there, but it could just be gas pains....have you called yet?

If this sounds all too familiar, listen to Dr. Hansen and make the call. As she notes in the article, if you were a 50 year old man with chest pains, you'd want to get checked out just in case, right? What you're feeling may be nothing, but it may be labor. Wouldn't you rather know?

Prescriptions don't always come with pregnancy warnings

Physicians prescribe medications for women of childbearing age all the time. However, new research shows women who could become pregnant often aren't receiving counseling regarding the risk of birth defects for some classes of medications.

If you're not up to speed on how medications are classified with respect to pregnancy outcomes, here's a quick primer. The Food and Drug Administration (FDA) classifies drugs based on how teratogenic they are - or what is their capacity to cause abnormal development in an embryo or fetus. The FDA uses 5 categories to denote levels of safety.

Class A drugs show no evidence of causing birth defects in studies of pregnant women. Class B drugs show no risk for birth defects in the second or third trimester. In the first trimester there either is no research on these drugs, or human studies did not demonstrate adverse effects, while animal studies did. Class C drugs are those that either have caused birth defects in animal studies and there are no studies of women, or no studies (either animal or human) exist at all, so risks are unknown. Class D drugs have been shown to cause birth defects, but the benefits of use outweigh the known risks, as in the case of life-threatening illness or serious disease. Finally, Class X drugs have been shown to cause birth defects, and they are not recommended during pregnancy.

In a study published this week in the Annals of Internal Medicine, investigators reviewed the health records of nearly 500,000 women ages 15-44 in northern California, including detailed information about medications prescribed, prescriptions filled, and contraceptive use and counseling. They found that 1 in 6 women was prescribed a Class D or X drug, and internal medicine and family practice docs prescribed the largest share of these drugs. They also found nearly one-half of women who were prescribed a Class D or Class X medication did not receive any contraceptive counseling, even though these drugs are known to cause birth defects. Finally, fewer than one-half of women who filled a prescription for a Class D or Class X drug also filled a prescription for contraception or had previously been sterilized.

Why does this matter? Unplanned pregnancies are not rare - in fact research shows that 50% of American women ages 15-44 will have at least one unplanned pregnancy in her lifetime. As a woman of childbearing age, this may be one of those instances where you have to be proactive in your healthcare. If you're sexually active - or have even the remote possibility to be - and your doctor prescribes a new medication, you may want to ask about the risks during pregnancy, just in case. Better to have one awkward moment in the doctor's office than 40 weeks of wondering if your newborn is going to be healthy.

Facebook breastfeeding debate driving you to drink? Not so fast...

If you've been keeping up with the discussions about Facebook letting pro-anorexia members freely mingle (despite research that says "pro-ana" websites are bad for women) while they ban breastfeeding moms for posting pictures of their children eating (despite research that shows breastfeeding is good for women AND their children), you'll know it's enough to drive anyone to drink.

Not so fast. While research does suggest women may receive some benefits from alcohol consumption, new research published yesterday in the online version of the International Journal of Cancer shows caution is in order.

Researchers followed over 41,000 postmenopausal women of diverse ethnic backgrounds, including African-American, Japanese-American, Latina, Native-Hawaiian and White women. They tracked the women for an average of 8 years and recorded their dietary intake (including alcohol consumption), lifestyle decisions, genetic risk factors, and health outcomes. The investigators found women who drank 2 or more alcoholic beverages of any kind (wine, liquor, or beer) daily had twice the risk of contracting endometrial cancer (cancer of the lining of the uterus) as women who did not drink. They did not find an increased risk for endometrial cancer among women who consumed less than 2 alcoholic drinks daily.

When they separated women according to their preferred/most often consumed beverage, there were differences in rates of endometrial cancer. Women who drank 2 or more servings of wine daily were 3 times as likely to develop endometrial cancer as non-drinkers. Women who drank just 1 or more servings of hard liquor were on average twice as likely to develop endometrial cancer as those who abstained. The investigators did not find any differences among women who preferred beer, mostly because few women identified beer as their primary drink of choice.

The investigators also studied alcohol consumption in relation to other risk factors for endometrial cancer, such as body mass index, history of pregnancy, use of hormone replacement therapy, and smoking. They found lean women (women with a BMI less than 25) who consumed at least two drinks daily had greater risk for endometrial cancer than overweight and obese women. Women who never gave birth also were at greater risk for endometrial cancer if they consumed 2 or more drinks daily. Smokers and women who used hormone replacement therapy did not show increased risk for endometrial cancer based on their alcohol consumption.

So while you may derive some health benefits from enjoying your favorite libation, there also are some risks if you get too carried away too often. In addition to "how many" drinks you have, be mindful of how much you pour into a glass. (Do you ever notice a bottle of wine lasts longer in a restaurant - when someone else is pouring - than it does at home?). Here's a guide to standard serving sizes (yes, that reads 5 ounces for a glass of wine). Bottom line: moderation is key.

Pro-Anorexia Websites Bad on All Counts

As lactivists continue to fight for the rights of breastfeeding moms everywhere, my husband over at It's Not a Lecture pointed out that while Facebook is banning photos of breastfeeding moms - and banning the moms themselves in some cases - they continue to let pro-anorexia members mingle and meet using their network. I don't want to get in the middle of a communications debate on this blog - I'll leave that to the PR experts (is that an oxymoron?). However, I do think the timing of this study in the International Journal of Eating Disorders is very interesting.

Researchers investigated the mental and emotional effects of three types of websites on 235 college women: a pro-anorexia website, a women's fashion website, and a home decor website. They found that compared to women who viewed the fashion and home decor sites, women who viewed the pro-anorexia site were more likely to feel negative emotions, to have poor social self-esteem, and to not feel confident about their appearance after 25 minutes of navigating the site. They also were more likely to feel heavy, to want to exercise more, to think about their weight, and to compare themselves to images of thin women on the site. Essentially, women who viewed the pro-anaorexia site felt worse about themselves, worse about their bodies, and worse about their appearance.

I don't know if the folks at Facebook care about the research. I do know the unfortunate reality is that young women looking for "pro-ana" friends don't need Facebook to find each other. There are plenty of pro-ana websites with chat room capabilities on the web - and you can access many of them without even registering. Ultimately, I think it's up to parents to protect their daughters: monitor what they access on the internet and on social media sites, and perhaps more importantly, love them and instill in them a sense of worth and self-confidence. Also know if, despite your best efforts, they develop the disease, there is help.

Pump it up: Strength training key for premenopausal women

Few women need to be convinced that exercise is good for them. Yet many women find it very difficult to make exercise part of their lives. The reasons for not exercising abound. I'm too tired. I don't have time. It's too cold/hot/rainy outside. A gym membership is too expensive. I've tried exercise before, but I didn't lose weight. I can't get motivated. You get the picture.

New research, however, suggests that just two weekly, one-hour dates with weights can have important positive health benefits for overweight and obese premenopausal women.

Investigators randomly placed 164 women into one of two groups: (1) a treatment group, where women were taught a stretching and weight-lifting routine that included both machines and free weights; and (2) a non-treatment group, where women were mailed an informational brochure from the American Heart Association on the recommended 30-minutes daily of moderate exercise. Both groups were told not to change their eating habits, and they were followed for two years.

Although the women in the treatment group did not lose weight, they did experience changes in their body composition. The women had less total body fat, a lower overall percentage of body fat, and less abdominal/mid-section fat. Further, the women who did not lift weights actually showed increases in total body fat, in the ratio of body fat to lean body mass, and in abdominal fat. The increase in belly fat is particularly concerning, because it is associated with higher risk for cardiovascular disease and metabolic disorders, including the metabolic syndrome.

The investigators suggested that strength training can help to slow weight gain and the development of obesity in women, which is on the rise. If you currently exercise but do not strength train, you might think about adding weights to your weekly routine - especially if you are overweight. Here are some weight training tips from the Mayo Clinic, as well as a slide show of strengthening exercises for major muscle groups. And for those of you who do not exercise at all, check with your doctor. Once you get the okay, there are a number of reliable resources to get you moving. And as for those excuses...

Avandia - the next Vioxx?

In two studies published in JAMA today, it appears that a popular class of drug for diabetes, known as thiazolidinedione (popular brand names = Avandia [rosiglitazone] and Actos [pioglitazone]) is causing some heart problems. Avandia was found to increase risk for heart attack by 42% and double the risk of heart failure. Actos also was found to increase the risk of heart failure, although it reduced risk of heart attack, stroke and death.

Actos and Avandia are used most often in the treatment of type 2 diabetes. The drugs act on similar mechanisms to lower glucose (blood sugar) levels in the body. They can be prescribed alone, or in conjunction with other therapies, such as insulin.

This is not the first time research has suggested these drugs may cause serious cardiac events. This past May, the New England Journal of Medicine published two studies that also revealed Avandia caused some heart problems. In response, a federal advisory panel met to discuss the drug and voted to keep it on the market. The FDA also placed stricter warnings on both Avandia and Actos in June.

Does this sound familiar? Drs. Solomon and Winkelmayer seem to think so. They wrote a great piece on common threads between the Vioxx case and the current findings on Avandia. It seems the jury is still out, because at present GlaxoSmithKline is keeping Avandia on the market. However, if this does become another Vioxx, let's hope GSK doesn't wait too long to do the right thing.

Meantime, if you're taking Avandia or Actos, you may want to discuss this new research with your health care provider. You also want to remember that good nutrition, exercise, and maintaining a healthy weight are also important for managing your type 2 diabetes.