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Among people aged 75 and older, the herbal supplement Ginkgo biloba does not prevent heart attacks, stroke or death, a new study finds.

There is some evidence that the popular herbal remedy might help prevent the leg-circulation problem known as peripheral artery disease, however.

Ginkgo contains nutrients called flavonoids, which are also found in fruits, vegetables, dark chocolate and red wine, and are believed to offer some protection against cardiovascular events, the researchers say. The supplement, which is popular in the United States and Europe, has been touted to improve memory, and to prevent dementia, heart disease and stroke.

However, “ginkgo had no benefit in preventing heart attack or stroke,” said study lead researcher Dr. Lewis H. Kuller, distinguished university professor of public health and professor of epidemiology at the University of Pittsburgh.

“But, surprising to us, was that the results were consistent with the observations in Europe that ginkgo appeared to have some benefit in preventing peripheral vascular disease,” he said.

This could be due to flavonoids acting as both antioxidants and also causing blood vessels to expand, Kuller said.

The report was released online Nov. 24 in advance of publication in an upcoming print issue of the journal Circulation. Last year the same University of Pittsburgh team reported that ginkgo biloba had no effect on preventing dementia.

For their latest study, Kuller’s group randomly assigned 3,069 patients to 120 milligrams of highly purified ginkgo biloba or placebo, twice a day as part of the Ginkgo Evaluation of Memory Study.

Over the six years of the trial, 385 participants died, 164 had heart attacks, 151 had strokes, 73 had mini-strokes (”transient ischemic attacks”) and 207 had chest pain, the researchers found.

There was no significant difference between those taking ginkgo or placebo for any of these outcomes, Kuller said.

However, among the 35 people who were treated for peripheral artery disease, 23 received placebo and 12 were taking ginkgo — a statistically significance difference, the researchers noted.

About 8 million Americans have peripheral artery disease, which typically affects the arteries in the pelvis and legs. Symptoms include cramping and pain or tiredness in the hip muscles and legs when walking or climbing stairs, although not everyone who has PAD is symptomatic. The pain usually subsides during rest.

“This study demonstrated that there were absolutely no benefits of ginkgo biloba in reducing cardiovascular events such as heart attack or stroke or in reducing death due to cardiovascular disease,” said Dr. Gregg A. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles.

“Individuals interested in maintaining cardiovascular health should stick to interventions that have been proven to be beneficial, including not smoking, engaging in regular exercise, and maintaining healthy weight, blood pressure and cholesterol levels rather than taking herbal supplements,” Fonarow said.

Mark Blumenthal, founder and executive director of the American Botanical Council, an independent non-profit educational organization, pointed to the study’s more positive outcome.

“I believe it is important to emphasize that the results of this current exploratory trial do not in any manner reduce or negate the existing positive results of ginkgo biloba as an effective treatment in peripheral artery disease patients, which has been evaluated, confirmed, and approved by government regulatory drug authorities in leading Western European countries like Germany and France,” he said.

In addition, Blumenthal said, the trial showed that ginkgo biloba was safe and well-tolerated.

Three-stage graduated licensing for teens and other new drivers prevents injuries and saves lives, say U.S. researchers who analyzed five years of crash data from six states — Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.

More than 300 lives could have been saved if all of these states had added new, evidence-based modifications to their graduated driver’s licensing (GDL) programs, study leader Dr. Timothy Corden, an associate professor of pediatrics at the Medical College of Wisconsin, and colleagues reported in a university news release.

The study authors also concluded that more than 21,400 traffic injuries could have been prevented if all these states had instituted at least five of seven components recommended by the Insurance Institute for Highway Safety:
Minimum age of 16 years for obtaining a learner’s permit.
A waiting period of at least six months after obtaining a learner’s permit before applying for an intermediate-phase license.
At least 30 hours of supervised driving.
Minimum age of 16.5 years for entering the intermediate phase.
No unsupervised driving at night after 10 p.m. during the intermediate phase.
No unsupervised driving during the intermediate phase with more than one passenger younger than 20.
Minimum age of 17 for a full license.

“Our study lends support for states moving to include more of the best-practice components included within the Insurance Institute for Highway Safety recommendations for state GDL regulations,” the researchers said. “This could be viewed as a ‘policy treatment prescription’ capable of keeping teenagers alive and families intact.”

While some politicians may be reluctant to revise GDL laws, parents are generally supportive of GDL programs and play an important role in the development of successful GDL policies, the researchers said.

Some herbal supplements may boost the levels of lead in the blood of women, new research shows.

Among 12,807 men and women age 20 and older, Dr. Catherine Buettner, at Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues found blood lead levels about 10 percent higher in women, but not men, who used specific herbal supplements.

When they examined herbal supplement use among women of reproductive age (age 16 to 45 years old), “the relationship with lead levels was even stronger, with lead levels 20 percent higher overall, and up to 40 percent higher among users of select herbal supplements compared to non-users,” they report in the Journal of General Internal Medicine.

Lead accumulates in the body over time and may pass from a woman’s placenta and breast milk to developing fetuses and infants. The U.S. Food and Drug Administration does not specify safe lead limits, or even routinely test for this toxin in herbal supplements.

Buettner’s team found that women using Ayurvedic or traditional Chinese medicine herbs had lead levels 24 percent higher than non-users, while those using St. John’s wort and “other” herbs had lead levels 23 percent and 21 percent higher, respectively, than non-users.

When combined with prior studies hinting at excess lead in specific supplements, the evidence strongly suggests use of specific herbal supplements may result in higher lead levels among women, Buettner said.

In the current study, Buettner was reassured to find “no evidence of lead toxicity,” she told Reuters Health in an email.

The researchers point out that the use of some herbal supplements among study participants was low, which limited the power to detect associations among specific herbal supplements.

They also emphasize that the current study does not prove that herbal supplements cause higher lead levels. They urge further studies to analyze how other lead exposures, calcium intake, or use of other dietary supplements alter lead levels.

Dr. Adriane Fugh-Berman, at Georgetown University Medical Center in Washington, D.C. concurs in an editorial on the study, and also cautions, “let us not use too broad a brush to tar all herbal products.”

Specific analyses of specific herbal products or the blood of users, Fugh-Berman writes, should be used to establish products containing problematic amounts of lead.

A shorter, more intense course of whole-breast radiation works as well as the traditional six-week course, at least for some early-stage breast cancers, a new study shows.

“This concept of a shorter length of treatment is gaining acceptance,” said Dr. Manjeet Chadha, associate chair of radiation oncology at Beth Israel Medical Center and associate professor of radiation oncology at Albert Einstein College of Medicine, both in New York City. Chadha led the study and is scheduled to present the results Wednesday at the American Society for Radiation Oncology annual meeting, in Chicago.

Researchers previously have tried to investigate whether they can alter the duration of radiation therapy or the volume, Chadha said. “My study focuses on the duration of it,” she said.

In her three-week treatment — called accelerated hypofractionated whole breast irradiation — a woman gets the entire affected breast irradiated and receives a ”boost,” or extra dose, at the site where the tumor was removed. Other approaches include giving a boost dose after the entire radiation treatment to the whole breast is completed.

Chadha’s study is ongoing, but she planned to report on 122 patients with early-stage breast cancers who underwent lumpectomies followed by the accelerated treatment. They were then tracked for a median of two and a half years (half followed longer, half less). The patients’ median age was 66.

No relapses were noted, and the three-year survival rate was nearly 95 percent, Chadha said.

”It sounds encouraging,” she said of her results. To further evaluate the accelerated treatment, she compared the first 50 patients on the briefer approach to a matched group of 70 patients who got the more traditional six-week radiation treatment.

Side effects, such as skin irritation and redness, were similar, she found. ”There was no difference in fatigue or breast edema [swelling],” she said. The cosmetic results were satisfactory, too.

The new study adds some valuable information for doctors trying to decide for individual women which radiation treatment approach might be best, said Dr. Nayana Vora, a professor of radiation oncology and associate member of the developmental cancer therapeutics program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

”It’s a short follow-up,” she said, noting that some side effects may surface later. But, she noted that a study outside the United States that looked at the briefer treatments has followed patients for up to 12 years with results similar to Chadha’s study.

”Very few studies have been documented in the U.S. with external whole beam [to the whole breast] and a concomitant boost,” Vora said. ”It tell us that, yes, patients can be treated with a short course of radiation treatment. Will it become the standard of care? I don’t know.”

While Vora typically offers her patients the six-week treatment unless they can’t commit to that time period because of transportation problem or other obstacles, she said she now may consider the shorter treatment.

In another study to be presented at the oncology meeting, researchers reported that breast cancer patients who have a mastectomy and then receive radiation to the lymph nodes behind the breast bone (the internal mammary lymph nodes) do not live longer than those who don’t get those nodes treated.

The study evaluated 1,334 women with stage 1 or 2 breast cancers that had spread to the axillary lymph nodes under the arms or whose original tumor was in a central, internal location. All got radiation to the chest wall and nodes above the collar bone. But half got the internal mammary radiation and half did not.

After a decade, survival differences between the groups were small, with 60 percent of those who didn’t get the extra radiation still alive, and 63 percent of those who got it surviving.

Most radiation oncologists are reluctant to radiate the internal mammary nodes, Vora explained, because of their proximity to the heart.

Many patients don’t like how long it takes to receive the results of radiology tests and aren’t happy with the lack of information when they do get the results, a U.S. study has found.

Radiology imaging tests include MRI, CT, ultrasound, mammography and X-ray.

“Most of the patients in our study were decidedly dissatisfied with how they find out about their radiology test results. Specifically, they were unhappy with the delay before getting results and the lack of detail when they do find out what the tests showed,” lead investigator Dr. Annette J. Johnson, an associate professor of radiology at Wake Forest University School of Medicine, said in a university news release.

“The classic, most common story we heard was that the patient went to her doctor for a symptom such as pain, was sent for an MRI and then heard nothing until their next regular doctor’s appointment,” Johnson said. “Then, when the patient asked what the MRI showed, her doctor gave a generic answer — ‘Everything was fine.’ The patients in our study said that they don’t want to hear ‘fine’ weeks after the test. They want to know details and they want to know them as soon as the results are in.”

The patients in the study were asked about their experiences with radiology imaging tests, what they want to know from the tests, and how they would like to learn about the results.

Johnson and colleagues found that patients “want their results quickly, in writing, and they want detailed information about the test results in language they can understand.”

Many patients said they’d like a secure way to see their results online as soon as they’re available. That would give them time before the next doctor’s appointment to prepare questions, learn more about their condition or disease, and get a jump on setting up referrals if needed. Being able to see their test results would help them play an active role in their care.

The National Institute on Aging (NIA), part of the National Institutes of Health, today announced the award of $29.5 million in grant support over the next two years to determine whether a specific physical activity program can stave off disability in older people. The funding will begin the Lifestyle Interventions and Independence for Elders — LIFE — trial, the largest ever undertaken to prevent mobility disability among older people who are at risk of losing their ability to walk and to live independently in the community. The grant is being awarded to the University of Florida’s Institute on Aging in Gainesville.

The first two years of the six-year, eight-site LIFE trial are being funded through the American Recovery and Reinvestment Act. The grants are part of the $5 billion that President Obama announced Sept. 30 on the NIH campus.

“There is a lot of evidence indicating that exercise can help in preventing diseases, such as diabetes, among older people. But we do not know whether and how a specific regimen might prevent walking disability in older people who are at risk of losing mobility,” said NIA Director Richard J. Hodes, M.D. “This research is critically important at a time when the population is aging and new interventions should be sought to keep people healthy and functioning in the community longer.”

At eight sites around the country, LIFE will involve 1,600 people aged 70 to 89, who at the start of the study meet its criteria for risk of walking disability, defined as the inability to walk a quarter of a mile or four blocks. About 200 participants will be enrolled at each of the study sites, which include the University of Florida; the University of Pittsburgh; Northwestern University School of Medicine in Chicago; Stanford University in Palo Alto, Calif.; Pennington Biomedical Research Center in Baton Rouge, La.; Yale University in New Haven, Conn.; Tufts University in Boston and Wake Forest University School of Medicine in Winston-Salem, N.C. Wake Forest will also coordinate the data management and analysis.

“Limitations in walking ability compromise independence and contribute to the need for assistive care,” said Evan C. Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology, whose program is overseeing the trial. “Older people with impaired walking are less likely to remain in the community, have higher rates of certain diseases and death, and experience a poorer quality of life. A successful intervention might help prevent these bad outcomes.”

“We know that many older people have chronic health problems that affect their ability to walk,” said Jack Guralnik, M.D., Ph.D., chief of the NIA’s Laboratory of Epidemiology, Demography and Biometry and co-principal investigator of the study. “Arthritis, muscle weakness and poor balance can all affect how well and how far a person can walk. And, some older people have all of these problems. We will test the LIFE intervention in this population to see how it works in a real-world setting.”

Study participants will be randomly assigned to one of two groups. One group will follow a structured intervention consisting of walking at moderate intensity, stretching, balance and lower extremity strength training; the control group will participate in a health education program. The participants will be followed for about three years. Researchers will evaluate whether, compared to health education, the physical activity intervention reduces the risk of major walking disability, serious fall injuries and disability in activities of daily living, and whether it improves cognitive function. They will also assess the cost-effectiveness of the intervention.

“This will be the largest randomized controlled trial to prevent major mobility disability ever conducted in older persons who are at high risk of losing their physical independence,” said Marco Pahor, M.D., director of the University of Florida’s Institute on Aging and study principal investigator. “Typically, this population is excluded from large trials, and from this perspective the LIFE study is unique.”