Health Briefs

June 7 , 2002

Young Men, Obesity & Heart Disease
During the Vietnam War, autopsies performed on young men who died in battle revealed that coronary artery disease begins to occur shortly after adolescence.  Today, an epidemic of obesity has afflicted both young and old in our land of plentiful and fat-ladened food, and the ubiquitous presence of effort-reducing devices.  A study in the current issue of the journal Circulation provides further insight into the impact of obesity in young men on cardiac health.  In this study, autopsies were performed on 3,000 men and women, aged 15 to 34, who died primarily from trauma.  The arteries of the heart and kidneys were evaluated for changes due to atherosclerotic plaques and high blood pressure, respectively.  The blood was assessed for cholesterol levels, byproducts of tobacco smoke and sugar levels.  Finally, the deceased young men and women were evaluated for obesity using standard assessments.  The study’s authors found that obesity in young men was significantly associated with narrowing of the coronary arteries, elevated blood cholesterol levels, high blood pressure, and diabetes or pre-diabetes.  Among the young women studied, only minimal coronary artery narrowing was identified, and then primarily in the obese women with large abdominal fat pads.

This study dramatically confirms previous research suggesting that men are generally at greater risk of developing heart disease, and particularly in the presence of risk factors such as obesity and smoking.  Moreover, this study provides compelling evidence that the adverse health effects associated with obesity can be identified in very young men who are obese.  For the first time in history, more than 50% of Americans, both young and old, are overweight.  While it has often been said that it is never too late to adopt a healthy lifestyle, it might also now be said that it is never too early, particularly for men.

Breastfeeding & Obesity
Speaking of adopting a healthy lifestyle as early as possible in one’s life, this week’s Lancet features a study of 32,200 Scottish children, aged 39 to 42 months, that assessed the impact of breastfeeding on weight gain.  The study attempted to control for variables such as socioeconomic status, weight at birth and gender between the children that were breastfed as babies and those that were fed by bottle.  The researchers found that breastfed babies were 30% less likely to be obese than babies who took a bottle instead of the breast.  While this study did not control for all conceivable variables between the two groups of babies, it does strongly suggest that breastfeeding—or some factor(s) associated with breastfeeding—appears to reduce the incidence of obesity in babies.

Irritable Bowel Syndrome & Rectal Pain Threshold
Irritable Bowel Syndrome (IBS) is a poorly understood syndrome that generally manifests as crampy abdominal pain and sudden bouts of diarrhea.  Occasionally, intermittent constipation alternates with diarrhea.  IBS more commonly affects women, and has been variously attributed to nervous disorders, autoimmune disease and infection.  However, the symptoms of IBS overlap with many other gastrointestinal problems, making the diagnosis of IBS somewhat tricky.  A study in the journal Gastroenterology evaluated the use of an inflatable balloon placed in the rectum of patients with IBS and other non-IBS gastrointestinal ailments.  The study found that patients with IBS have a much lower threshold of discomfort than patients with other GI diseases when the balloon was distended within the rectum.  They conclude that this test, unpleasant as it sounds, may be an especially accurate means of discriminating IBS from other gastrointestinal disease syndromes with similar symptoms.

More Data on COX-2 Inhibitors & Cancer
I have rather frequently discussed the apparent association between COX-2 enzyme inhibiting drugs, such as Celebrex and Vioxx, and a reduced risk of colorectal cancer and other cancers.  The journal Gastroenterology has also just published a study that assessed 145 esophageal tumors for COX-2 enzyme activity.  The study found that patients with elevated expression of the COX-2 enzyme in their esophageal tumors had a significantly worse 5-year survival rate (35%) than patients with low COX-2 expression (72%).  These findings further support a possible role for COX-2 enzyme expression in the formation and progression of at least some types of cancer, and the potential use of COX-2 enzyme inhibitors to prevent certain cancers in patients who are at increased risk of developing these diseases.

Briefly…
Clinical Cancer Research:  Herceptin is a recently approved drug that blocks a breast cancer growth factor known as HER2/neu.  This growth factor is present in about 30% of breast cancers, and these cancers are often more aggressive than those that do not over-express the HER2/neu protein.  Herceptin is an antibody that blocks a single site on this growth factor, and has been shown to increase survival in patients with HER2/neu-positive breast cancer.  New research shows that antibodies directed against multiple sites on the HER2/neu protein appear to be even more effective at killing breast cancer cells (in cell cultures) than Herceptin.

Clinical Evidence:  An exhaustive review of the world’s medical literature regarding the measles-mumps-rubella vaccine (MMR) has concluded that there is no evidence that the vaccine causes autism or inflammatory bowel disease.  On the other hand, MMR appears to be extremely effective in preventing the three viral diseases that it is supposed to protect against.  In terms of public health benefit, MMR provides exceptional protection against measles and rubella, which are capable of causing significant illness, and even death.  Previous studies linking MMR to autism and inflammatory bowel disease were found to be poorly performed and statistically non-significant.

Archives of Medicine:  Helicobacter pylori (H. pylori), a stomach bacterium linked to ulcer formation and stomach cancer, may play a role in certain forms of glaucoma.  Glaucoma is a disease that can threaten vision due to elevated fluid pressure within the eye.  Forty-one glaucoma patients and 30 age-matched patients without glaucoma were tested for H. pylori with biopsies of the lining of the stomach.  The study found that 88% of the glaucoma patients had H. pylori infections of the stomach, as compared to 47% of the non-glaucoma patients.  Following treatment with antibiotics, 83% of the H. pylori infections were eradicated.  Two years after the treatment was completed, the glaucoma patients in whom the antibiotics were effective actually experienced a reduction in their intraocular pressures, and an improvement in their vision.

Dr. Robert A. Wascher