Welcome to LifeScore.com! - Prevention Information

1. Are short exercise sessions as effective as longer ones for reducing cardiovascular risk?

Yes. As long as the short sessions add up to the same energy expenditure as the long session. The Harvard Alumni Health Study followed 7307 men (average age 66.1) from 1988 to 1993. The researchers found that longer sessions did not have a different effect on risk compared with shorter sessions as long as the total energy expended was the same. Higher levels of energy expenditure did significantly predict decreased cardiovascular risk (Circulation 2000; 102:981-986).

For many people with busy schedules, two or three 10 to 15 minute sessions per day may be more convenient than a single 20 to 45 minute session. The key to success is making sure that the total amount of time spent exercising still adds up to, ideally, 30 to 45 minutes per day.

Yes. Someone who is moderately active lives at least two years longer than a sedentary person. A simple formula states that for each hour of exercise, you will prolong your life by two hours. After stopping cigarette smoking, exercise is the single most important lifestyle decision for improving health and longevity.

Exercise strengthens the heart, lowers risk for colon and breast cancer, strengthens bones, lowers risk for diabetes and stroke, lowers blood pressure, boosts the immune system, combats depression, and maintains muscle mass as we age (strength training is best for this).

The Cooper Clinic in Dallas studied 25,000 men over a 20-year period and found that the least fit men had a 70% higher risk of death from cardiovascular disease. The less fit men were also 50% more likely to die from all causes. Similar results were found in a smaller cohort of women.

The Cooper Clinic also found that the least fit 20% were 3.7 times more likely to develop diabetes over a six-year period, compared with the most fit 40%. Exercise enhances the muscle's ability to respond to insulin and remove sugar form the circulation. Exercise also lowers body fat, which is implicated in the development of diabetes.

Being sedentary increases the risk for colon cancer by at least 20% (some studies show a doubling or tripling of risk). Evidence also suggests risk for breast and prostate cancer is reduced.

As we age, muscle and bone strength is essential for maintaining an independent lifestyle, and avoiding the kind of physical deterioration that often ends in a nursing home.

Physical activity appears to stimulate the production of new white blood cells and remove older ones, thus boosting our immune defenses and helping to stave off infection and even cancer.

Finally, a study at Duke University showed that aerobic exercise worked just as well as drugs in alleviating depression, although the effect took longer to achieve.

1. What are the essential fatty acids (EFAs) and why are they important for health?

EFAs are essential to our diet because our bodies cannot manufacture them. They are important components of nerve cells, cell membranes, and biochemical messengers such as eicosanoids (see below). There are two groups of EFAs- omega-6 and omega-3. Each group has a parent compound which gets biologically converted into derivative fatty acids. The parent omega-6 fatty acid is linoleic acid, found in safflower, sunflower, sesame, corn, and soybean oil. Its most important derivative is GLA (gamma-linolenic acid), found primarily in borage oil, hemp oil, and evening primrose oil. The omega-3 parent fatty acid is alpha-linolenic acid, found in flax, perilla, hemp and pumpkin seed oils, and in canola and walnut oil. Its key derivatives are EPA and DHA, both found in cold water fish (salmon, mackerel, herring and tuna).

Eicosanoids are short-lived biochemical messengers. The typical western diet tends to favor the production of eicosenoids that promote blood clotting and chronic inflammatory processes. Getting adequate amounts of GLA, EPA and DHA favors the production of eicosenoids that inhibit blood clotting, relax blood vessels, lower blood pressure, and prevent inappropriate chronic inflammatory processes that underlie atherosclerosis, arthritis, asthma, and auto-immune disease. The western diet has high amounts of saturated fats (animal origin) and polyunsaturated fats that have been artificially hydrogenated (vegetable origin). These fats are associated with many chronic disease processes. Numerous studies have shown that diets supplemented with GLA, DHA and EPA lower blood pressure, lower LDL cholesterol and triglycerides, raise HDL cholesterol, reduce insulin resistance (which can lead to adult onset diabetes), reduce the harmful cardiovascular effects of stress, and reduce age-related senility. Omega-3 and omega-6 fatty acid supplements, in combination with a healthy diet, can improve cardiovascular function and prevent the underlying biochemical processes that often lead to chronic disease.

American eating habits are getting worse. The Department of Agriculture has documented some alarming trends. To begin with, people are consuming 350 more calories per day. An extra 100 calories per day without an increase in activity can add 10 pounds per year in excess weight.

Two income families and a booming economy mean more meals eaten outside the home. At least 1/3 of calories are now eaten at restaurants, up from less than 1/5 in the late 70's. Restaurant food is higher in fat and lower in fiber and calcium than home-cooked meals. Time-harried Americans are foregoing three square meals a day and instead eating almost continuously. Snacks are getting bigger. For example the average size of a muffin was 1.5 ounces in 1957, whereas now they weight in at 8 ounces! Back then, the typical fast food hamburger had about an ounce of cooked meat. In 1997 it had 6 ounces. A soda serving was 8 ounces, but today consumers swallow 32 to 64 ounces at a time. Movie popcorn has increased from an average 3-cup size to 16 cups!

The Agriculture Department's Healthy Eating Index shows that 88% of Americans do not consume the daily recommendations in primary food groupings, which include grains, vegetables, fruits, milk and meat. Fruit intake ranked lowest, with only 17% eating the recommended quantities (two to four piece minimum/day).

The average American is eating 197 pounds of red meat per year, up 64 pounds from 50 years ago.

Trans fatty acids, which are just as dangerous as saturated fats, have increased dramatically in the average diet, but are not even listed on nutrient labels. They can be found if all sorts of foods, from French fries to packaged baked goods.

Over the past fifty years, sugar consumption has increased by 45 pounds or 41%, up to 154 pounds per person per year. In 1945, Americans drank 4 times more milk than soda, but now drink 2 ½ times more soda than milk. Sodas have become the primary drink for Americans. Carbohydrate consumption in refined cereals and flour products has increased from 45 pounds annually in the 1950's to 200 pounds per person.

All this overeating means obesity is on the rise. At least 55% of the nation's 97 million adults are overweight or obese. Obesity increases risks for heart disease, high blood pressure, high cholesterol, and diabetes.

What will it take to get Americans to reassess their lifestyles and place more importance on the fast fading art of nutritious home cooking among family and friends?

Most Americans are familiar with the nutrition pyramid developed by the FDA. Here are several pyramids based on cuisine from other cultures. Each of these cultures has a very low incidence of cardiovascular disease. The Mediterranean Diet pyramid is based on a diet that has been shown in a prospective, randomized trial to reduce the incidence of recurrent cardiac events in people with known heart disease by up to 70% (source: the Lyon Heart Study)

The Latin American and Asian pyramids are also based on diets rich in plant foods. Also included is a Vegetarian pyramid. For more details, please visit the LifeScore® Food Pyramids page at: http://www.lifescore.com/pyramids.htm

A recent study in the Archives of Ophthalmology (2000; 118:1556-1563) found that people who took a multivitamin or a supplement containing vitamin C or E for more than 10 years had a 60% reduction in the risk of developing cataracts. Those who used the vitamins for less than 10 years did not have a beneficial effect. Cataracts are expected to triple in frequency over the next 50 years as the population ages. Vitamins most probably exercise their beneficial effect by protecting against oxidative stress. Because eye lens protein degradation occurs over decades, the protective effect of vitamins does not appear if they are taken over relatively short periods. Anti-oxidant vitamins work against the small day to day deterioration of body tissues, thus their protective activities take years to result in measurable beneficial effects.

According to Dr. Haim Rabinovitz, at the Shmuel Harofe Hospital in Tel Aviv, chromium is beneficial in those with type 2, or adult onset diabetes. He gave 200 micrograms of chromium twice a day to 39 diabetics for a three week period. Blood sugar levels dropped from an average of 189 to 150 mg/dl. Total cholesterol levels also dropped, from 225 to 211. Chromium appears to work by increasing the insulin sensitivity of cell membranes, thus improving the ability of insulin to remove sugar from the circulation. Adult onset diabetes is due to insulin resistance, a condition which decreases the ability of cell membranes to respond to insulin and transport sugar into the cell, where it can be used for energy generation.

3. Can Vitamin E and Fish Oil Be Effective in Treating Rheumatoid Arthritis?

A recent study using a mouse model found that a regimen of vitamin E and fish oil (omega -3 fatty acids) decreased the levels of proteins called cytokines that produce inflammation, which then leads to joint swelling and pain. These results point to a potential mechanism for the effects of these supplements.

In humans with rheumatoid arthritis, dietary supplementation with omega-3 fatty acids has consistently resulted in less joint tenderness and less morning stiffness. The dosage of the omega-3 fatty acid supplement was in the range of 3 grams per day, and 12 weeks of treatment was required before symptoms improved (A. J. of Clin. Nut. Jan 2000: 349S-351S).

Vitamin C is a water-soluble antioxidant vitamin. Studies have shown that blood levels of vitamin C are lower in people with coronary heart disease compared to controls. Possible mechanisms for increased risk with low vitamin C levels are:

Vitamin C is utilized in the synthesis of bile acids (which are secreted by the gall bladder to help digest fats) from cholesterol. Vitamin C deficiency may lead to accumulation of cholesterol in the liver, blood, and arteries, and thus provoke plaque formation.
Vitamin C stimulates blood levels of lipoprotein lipase (LPL) which helps remove triglycerides from the circulation. Low levels of vitamin C could therefore promote plaque formation through the raised triglyceride levels.
Vitamin C promotes connective tissue formation (hydroxylation of proline). Therefore low levels could affect the integrity of the arterial wall.
Low levels of vitamin C are associated with more chest pain (angina) in patients with heart disease.
One observational study in Chinese-Americans found that blood pressure, HDL cholesterol levels, and blood sugar levels were all adversely affected by low levels of vitamin C in the blood.

In addition, the following data supports a role of vitamin C in protecting against the development of coronary heart disease:

A large epidemiological study published in 1992 showed a risk reduction for heart disease of 45 percent in men and 25 percent in women consuming about 300 milligrams of vitamin C daily from their diet and supplements.
Over 20 clinical studies since 1996, published primarily in Circulation, have found beneficial effects of vitamin C on the relaxation of arteries, or vasodilation, which is an important risk factor for heart attacks and strokes.
Published research has found that vasodilation in patients with heart disease is significantly improved following supplementation with 500 milligrams of vitamin C a day, and is comparable to the vasodilation found in healthy people.
Beneficial effects of vitamin C supplements leading to normalization of vasodilation have also been observed in patients with angina, heart failure, high cholesterol levels, hypertension, diabetes and smokers.
A recent double blind, placebo-controlled clinical study published in Lancet demonstrated that 500 milligrams of vitamin C per day lowered blood pressure in moderately hypertensive patients.

In general, 500-2,000 mg per day of vitamin C is well tolerated and may have a beneficial effect on the arterial system. Vitamin C supplementation can be considered a potentially useful component of an overall program for reducing cardiovascular risk.

A common finding in diseased arteries (atherosclerosis or diabetes-related) is their inability to dilate, or relax, when such a response is needed to increase blood flow. Many studies have shown that vitamin E can protect LDL cholesterol from oxidation. Oxidized LDL cholesterol appears to prevent arteries from dilating, possibly by reducing local concentrations of nitric oxide, a molecule produced in the artery wall that causes dilation.

A recent article in Circulation (July 2000) treated young diabetics with vitamin E (1,000 IU for 3 months) in a randomized, placebo-controlled trial. Supplementation increased the vitamin E content of LDL cholesterol by 127%, and significantly reduced the susceptibility of LDL to be oxidized. This resulted in improved arterial relaxation, suggesting that vitamin E supplementation can restore function to diseased arteries.

This study lends further support to the hypothesis that vitamin E has a beneficial effect on the artery wall, and may play an important role in protecting arteries from damage in common conditions such as diabetes and atherosclerosis.

The first study to measure such an effect was reported in the journal Stroke (2000;31:568). The study tracked 60 African American men and women with high blood pressure. The participants underwent ultrasound of the carotid arteries and were then randomized to transcendental meditation ( TM ) or no TM. At the end of the trial, the TM group had a decrease in the thickness of their carotid artery wall, while the no TM group had an increase in the thickness. Such thickness is a measure of atherosclerosis, or plaque, in the carotid arteries. A decrease in thickness translates to a lower risk for stroke. The authors state that prior research has shown that TM programs decrease high blood pressure, cholesterol, and stress hormones. They believe the state of "restful alertness" may trigger self-repair mechanisms in the body which lead to regression of atherosclerosis.

Although such conclusions are still controversial, it makes sense to seek a balanced life, with periods for quiet reflection and spiritual repose.

Yes, it does. A study in the 12/20/2000 issue of the Journal of the American Medical Association from the Department of Public Health Sciences in Stockholm, Sweden, investigated this question. 292 women aged 30-65 who were hospitalized with heart attacks between February 1991 and February 1994 received psychosocial evaluations before discharge. After an average of almost 5 years of follow-up, it was found that marital women with the most marital stress had a 2.9-fold increase in their risk for another coronary event. Work stress, on the other hand, was not significantly related to future events.

These results are consistent with prior studies showing that lack of perceived social support in women is associated with increased risk of both first and recurrent heart attacks. The authors suggest two possible mechanisms for this effect: the emotional stress adversely affects cholesterol levels and blood sugar metabolism; the emotional strain may increase the release of stress hormones (like adrenalin) that raise blood pressure and heart rate, and make the blood more prone to clot. Increased marital stress may trigger heart attacks and promote the progression of plaque in the coronary arteries. This is yet one more study showing the importance of how we live our lives- we should all make a conscious effort to have relationships that are supportive, loving, and constructive.

3. What is the latest data on hormone replacement in women to prevent heart disease?

The HERS trial (Heart and Estrogen Replacement Study, 1998) followed 2,763 post-menopausal women with known coronary artery disease after randomizing them to estrogen/progesterone or placebo. The treated group did not have a lower rate of new coronary events. However, they did have a higher rate of thromboembolic events (dangerous clots) and gallbladder disease. More coronary events occurred in the first year and fewer occurred in years four and five.

The more recent ERA trial (Estrogen Replacement and Atherosclerosis, 2000) randomized 309 women with known heart disease to estrogen plus progesterone, estrogen plus placebo, or placebo. Angiograms of the coronary arteries were performed at enrollment and again after 3.2 years. No treatment regimen was able to slow the progression of disease in the coronary arteries. The treatments did lower LDL cholesterol and raise HDL cholesterol.

These studies cast doubts on earlier studies which did show a protective effect of hormone replacement. Until further studies are completed, women should consult with their primary care physician about the risks and benefits of hormone replacement therapy.

The statins- also called HMG-CoA reductase inhibitors. These drugs block the rate-limiting step in cholesterol synthesis in the liver. This, in turn, causes an increase in the activity of a liver receptor for LDL cholesterol, which then binds more LDL and removes it from the circulation, bringing it into the liver cells.

There are six statins:
1. Lipitor
2. Baycol
3. Lescol
4. Mevacor
5. Pravachol
6. Zocor

The main reason for taking a statin is to lower the LDL cholesterol. In general, LDL cholesterol is lowered 30-50%. Many large clinical trials have shown that statins can reduce risk of heart events by 20-40%.

Side effects are minimal. Liver function tests show mild abnormalities in 1-2%. Muscle inflammation may occur, but is reversible when the medication is stopped.

Statins have been shown to stabilize plaque, making it less likely to rupture and cause heart attacks, within 2-3 months of initiating therapy.

Niacin- is vitamin B3. At doses of 1.5 to 6 grams niacin inhibits cholesterol synthesis by the liver, increases the breakdown of LDL cholesterol (increased lipoprotein lipase activity), and reduces levels of fatty acids (which are used by the liver to make cholesterol). Niacin is very useful in people with LDL cholesterol pattern B (small LDL particle size), high triglyceride levels, elevated Lp(a), low HDL cholesterol, or high LDL cholesterol.

The main side-effect with niacin is flushing, which is harmless but can be uncomfortable. Rarely, there can be liver dysfunction or muscle tenderness. The time-release forms, such as Niaspan or Slo-Niacin, minimize the flushing effect.

Fibric Acid Derivatives- Atromid, Lopid, and Lipanthyl. Reduce triglyceride production in the liver. May also raise low HDL cholesterol when associated with high triglycerides. In the Helsinki Study, Lopid reduced triglycerides by 43% and reduced cardiac events by up to 71%. Main side effects are abdominal distress, gas, muscle pain, and elevated liver enzymes.

Bile Acid Resins- Questran and Colestid. These drugs bind bile acids in the intestine. Bile acids contain cholesterol, so the cholesterol is removed and not resorbed for return to the liver. They lower LDL by 25-30%. They tend to reduce small particle LDL (the most dangerous form) and are sometimes used for this purpose combined with niacin. Main side effects include constipation, gas, and cramping.

1. In general, which risk factor appears to be most predictive of future heart disease?

In the large Physician's Health Study, the risk of future heart attack was increased by the following amounts for each of the listed conditions:

1. Lipoprotein (a) - 1.3-fold
2. Homocysteine - 1.7-fold
3. Total cholesterol - 1.6-fold
4. Fibrinogen - 1.8-fold
5. Total cholesterol/HDL ratio - 2.8-fold
6. C-reactive protein - 3-fold
7. C-reactive protein and total cholesterol/HDL ratio - 5.1-fold

C-reactive protein is a non-specific marker for inflammation. The levels that are measured are actually very modest increases, and may in fact be a marker for biological aging. The aging process causes cumulative tissue damage from molecules that cause oxidative stress. Such a process appears to be more accelerated in some people, who then are prone to various chronic diseases that tend to increase in incidence after age 30. Monitoring C-reactive protein after treatments to reduce the low-grade inflammatory signs of aging will hopefully become an effective way to track success.

Coronary risk factors are physiologic and biochemical characteristics that can be used to assess risk for the development of coronary heart disease. For example, as blood pressure goes up, risk for heart disease goes up. Most risk factors increase risk in a fairly linear fashion, so there is no clear cut-off separating normal values from abnormal values.

The classic coronary risk factors were discovered by the Framingham study. They are:

The Framingham study took place form 1949 to the 1970's. Children of the Framingham subjects are also being studied, and new data continues to appear on these inhabitants of Framingham, Massachusetts. In addition, other researchers are finding new risk factors. Because coronary atherosclerosis (plaque) is a very complex process, there are many steps along the path to its development where certain genetic tendencies might make a person more or less susceptible to environmental influences.

For example, some people cannot clear LDL cholesterol from their circulation because there is an abnormality in the receptor that picks up cholesterol and brings it into the cells. If they eat very low fat diets, the receptor problem may never be an issue. But if they eat a typical American diet, their LDL cholesterol levels go up, and they are at increased risk for heart disease.

A recent report in the journal Diabetes Care concluded that the incidence of diabetes in Americans increased dramatically from 1990 to 1998. Among people in the 30-40 age group, there was a 76% increase in the disease. The cause of the increase can be attributed to the growing number of Americans who are overweight. Recent data shows more than 50% of Americans are now overweight, and the trend is continuing to rise. The incidence of diabetes will continue to grow because of the multi-year delay between weight gain and the onset of diabetes.

Americans are overweight because they are spending more and more time in front of their television and computer screens, and are avoiding activities that can burn calories and restore equilibrium between caloric intake and energy expenditure. In addition, food portions are increasing.

In general, there is a 4% increase in the risk of diabetes for every pound of excess weight. The prevalence of diabetes increased from 4.9% in 1990 to 6.5% in 1998. During the same period, the proportion of overweight people increased from 44% to 54%.

In addition to the increase in known cases of diabetes, it is estimated that 5 million Americans have diabetes but have not been diagnosed. Diabetes is a major cause of blindness, kidney failure, and leg amputations, and greatly increases the risk of heart disease and stroke.

Even though it is very important for diabetics to maintain good control of their blood sugar levels to avoid complications such as eye and kidney disease, evidence suggests that blood sugar control does nor impact risk of heart disease.

Researchers from the Massachusetts General Hospital analyzed results from 16 trials that examined the effects of blood sugar lowering, cholesterol lowering, and blood pressure lowering. Cholesterol lowering reduced the risk of cardiovascular death by 57% in diabetics with no prior heart disease, and also reduced the risk of heart attack by 57% in those diabetics who had suffered a prior heart attack.

Blood pressure control reduced the risk of cardiovascular death by 51% in those with no prior heart disease, and reduced the risk of heart attack by 31% in those with prior heart attacks.

Blood pressure control reduced the risk of stroke by 41% in diabetics. Cholesterol lowering reduced risk by 29%.

In contrast, good control of blood sugar levels did not confer any protective effect for heart attacks, stroke, or cardiovascular death.

When researchers compared the respective effects of blood pressure control and blood sugar control on risk for kidney failure, blood pressure control reduced risk by 52%, while good blood sugar control reduced risk by 29%.

These results suggest that there are metabolic abnormalities associated with diabetes that are independent of blood sugar level, and that these other abnormalities may be damaging the artery wall and promoting the build up of plaque. By lowering cholesterol and blood pressure, a protective effect is conferred on the artery wall, and this protective effect works better in diabetics than lowering their blood sugar. The major beneficial effect of lowering blood sugar is on the very small arteries and capillaries. When these small arteries are damaged, diabetics experience visual problems, kidney problems, and numbness of the extremities.

A new report (Archives of Int. Med. 7/9/01) analyzes data from the Nurses Health Study and the Health Professionals Follow-Up Study. Together, these studies have tracked over 170,000 people for over 10 years. The researchers found that weight had the most significant effect on risk for diabetes. As weight increased, risk rose 30 fold in women and 40 fold in men. Even those with high normal weights had twice the risk of diabetes compared with those of low normal weight. As weight increased, the risk for gallstones increased 3-4 fold, for high blood pressure 3-4 fold, for colon cancer 2 fold, for heart disease 1.7-2.4 fold, and for stroke 2.5 fold in men, but not in women. Risk for high cholesterol did not go up significantly in women, and went up only 1.6 fold in men.

Clearly, the greatest peril of increased weight is on risk for diabetes. Some of the extra weight becomes visceral fat, and some is turned into subcutaneous fat. Men, in general, have more visceral fat than women. Visceral fat can play havoc on our metabolism, causing high triglycerides, low HDL cholesterol, and insulin resistance, which can lead to type 2, or adult onset diabetes. 32% of Americans are now overweight, and another 22.5% are obese. Americans have been gaining weight for the past three decades. We can anticipate a significant increase in the consequences of weight gain, and this study illuminates just exactly what those consequences are! If you are overweight, consider this an important risk factor for the above conditions, and start to develop a pro-active plan for losing weight through improved nutrition and regular exercise.

2. Are environmental factors involved in the development of Alzheimer's disease?

A study in the Journal of the American Medical Association (JAMA, February 14, 2001) compares the rates of development of dementia and Alzheimer's in two populations- A Nigerian group and an Indianapolis group. The Nigerians were traders at small markets, were extremely poor, and ate primarily vegetables such as yams, as well as palm oil and small amounts of fish.

The Indianapolis group of American blacks consumed a typical American diet. The participants were evaluated once in 1992-93, and again in 1994-95, and finally in 1997-98. By the end of the study, the Americans had two to three times more dementia and Alzheimer's than the Nigerians (Dementia: 3.24% vs. 1.35%; Alzheimer's: 2.52% vs. 1.15%). The researchers suspect that vascular disease may explain the difference. The American group had much higher blood pressure and cholesterol levels. Other studies have shown a relationship between the incidence of Alzheimer's and the prevalence of small strokes visible on special brain scans.

There are 4 million Americans with Alzheimer's disease. An estimated 10% of the population has Alzheimer's disease by the age of 65, and nearly half have it by the age of 85. The disease causes brain damage, associated with the presence of a protein in the cells called amyloid. This study provides intriguing information suggesting that we may be able to lower the disease incidence by better controlling the risk factors for vascular disease such as high blood pressure and high cholesterol.

This is a somewhat controversial issue. There have been studies supporting such a relationship, while others have found no correlation. Two recent studies seem to confirm an adverse effect from these emotional parameters.

A new study in the Journal of the American Medical Association (JAMA) used coronary artery calcium scores to measure coronary atherosclerosis (plaque). Using a standardized test, hostility scores were measured in a group of 374 men and women aged 18 to 30. 10 years later, their calcium scores were measured. Those with hostility scores above the medium level had double the prevalence of coronary calcification compared with those below the medium. This is the first study to look for a relationship between hostility and early-stage atherosclerosis.

Other studies have shown that hostility is associated with an exaggerated morning blood pressure surge, and with more activated platelets (the little blood cells that initiate a clot). These are potential mechanisms underlying the adverse effect of hostility on the coronary arteries.

A second study in Circulation (the official heart journal of the American Heart Association) studied 12,986 black and white men and women aged 45 to 64 (participants in a large study called the ARIC study- ‘Atherosclerosis Risk in Communities’). Each participant completed a trait anger scale. Anger scores ranged from 10 to 40. Those who scored in the high anger range and had normal blood pressure were 2.6 times more likely to suffer a coronary event. Those with moderate vs. low anger scores were 40% more likely to have a coronary event. Those with high blood pressure did not differ significantly based on anger scores.

The researchers hypothesize that anger, through its stimulation of the sympathetic nervous system, causes the release of adrenaline, which, when chronically present in the circulation, damages the heart and arteries. Anger can also trigger acute coronary episodes by directly disrupting the atherosclerotic plaque, and making it more prone to rupture, which then attracts clot, which can narrow or close off the artery.

The bottom line? We all get angry occasionally, and blowing off steam is sometimes necessary. But if you are frequently angry and feel excessive hostility, you should seek psychological assistance to deal with its root causes, and try to eliminate them.

Yes, they are. The trend actually began in the early 1990's, and is continuing. The latest report (Annual Report to the Nation on the Status of Cancer) shows the incidence for all cancers falling 1.1% per year from 1994 to 1998. This follows a gradual increase in rates which occurred from the 1930's to the 1990's. However, the reductions are quite small when one considers the billions of dollars that have been spent on cancer research.

For breast cancer, the incidence rate rose 1.2% per year from 1992 to 1998, due to screening detecting earlier cancers. Death rates actually decreased 1.6% per year from 1989 to 1995, and 3.4% per year between 1995 and 1998.

For colon cancer, death rates fell 1.8% per year from 1992 to 1998, with screening accounting for the drop.

Prostate cancer incidence rose from the late 1980's to 1995 due to the introduction of the PSA test, which screens for prostate cancer. Since 1995, rates have stabilized. Cancer deaths have dropped slightly.

Lung cancer accounts for 13.2% of cancer cases and 28.5% of cancer deaths. Lung cancer incidence fell 1.6% per year between 1992 and 1998, due to a 2.7% per decline in men, and a leveling off of rates in women. Death rates during this period fell 1.9% in men and rose 0.8% per year in women. These improvements are related to the fall in tobacco use (prevention) and not better treatments.

These findings all stress the importance of prevention and early detection. At LifeScore®, we are identifying lung cancer, kidney cancer, and other cancers at the earliest possible stages of detection, with a significant improvement in cure rates.

Previous studies have shown that melatonin, a hormone produced in the pineal gland, can inhibit the growth of a variety of cancer cell types. This new study from the University of Milan in Italy (Prostate 2000; Nov 1:p238-44) demonstrated that when prostate cancer cells in lab cultures were treated with melatonin, cell proliferation was inhibited, and cell counts fell. Prostate cancer is diagnosed in 200,000 men each year, making it the most common form of cancer. 40,000 men die yearly from the disease. No studies have yet been conducted in humans.

A recent analysis by Dr. Kathleen Fairfield (Harvard Medical School) of the Nurses Health Study (a longitudinal study of over 80,000 female nurses), found an association between the amount of lactose a woman ingests and her risk for ovarian cancer. Women who consumed one or more servings of skim milk or low-fat milk daily had a 66% higher risk of ovarian cancer, compared with women who consumed three or fewer servings per month. For each 11 g/day increase in lactose consumption (the amount in a glass of milk), the risk of cancer increased by 19%.

Traditional recommendations for colon cancer screening call for sigmoidoscopy beginning at age 50. Sigmoidoscopes reach two feet up the colon, which is less than half the total length of the colon. Doctors believed that if no polyps or tumors were seen, the likelihood of abnormalities elsewhere in the colon was low. Two new studies published in the New England Journal of Medicine challenge this belief. These studies revealed that half the patients who had precancerous lesions in the upper colon had no abnormalities lower down. Sigmoidoscopy would not have detected these dangerous lesions.

Colonoscopy visualizes the entire colon, but is not covered by Medicare and most other insurers, except for high-risk patients. Sigmoidoscopy costs about $200, versus $12-1500 for colonoscopy.

Even though sigmoidoscopy or colonoscopy is recommended for all people over 50, less than 1/3 are following these recommendations. Colon cancer is the second most common cause of cancer deaths, exceeded only by lung cancer. It kills 56,000 Americans a year.

Yes. An interesting analysis of the scientific evidence recently appeared in Cardiovascular Reviews & Reports (January 2001). Both north and south of the equator, rates are highest in winter and lowest in summer. In many countries, there is a 50% increase in the winter months. Countries furthest from the equator experience the highest rates of coronary heart disease (CHD). The explanation is probably related to several known effects of temperature on the cardiovascular system. Low temperature on the face causes the peripheral arteries to constrict, which would impose an increased workload on the heart. Low temperatures may also stimulate blood clotting factors (this is supported by studies showing seasonal variations in stroke and clotting of the veins in the legs). Platelets (the little blood cells that clump to help form clots) are more active in winter months. Cholesterol levels are also higher in winter than summer. Other possible connections include higher cigarette sales in winter, higher fat intake, and higher levels of depression.

Weekly variations in heart disease exist. Studies of people who are employed show a disease peak at the beginning of the workweek, suggesting an association with work-related stress. Data from implanted defibrillators reveal that life-threatening arrhythmias have a Monday peak and weekend trough.

Daily variations in heart disease are also seen. There is an early morning peak in stroke, heart attack, rhythm disturbances, and sudden cardiac death. The association appears to be linked to the time of awakening, with events peaking within three hours of rising from bed. A study from Hawaii showed that tourists, who got up later, had a peak that was three hours later than the peak for natives. The reason for this peak may be the increase in stress hormones during the early morning. Adrenaline and other such hormones have a cyclical activity peaking after sunrise. Those with disturbed function of these hormone systems, such as diabetics, don't experience the same daily periodicity of cardiovascular events. Also, beta blockers, drugs which inhibit stress hormones, have been shown to exert their beneficial effect on heart disease mortality by reducing the incidence of these early morning events.

Yearly, weekly, and daily biological rhythms seem to play an important role in health and disease. The above examples demonstrate the importance of environmental influences, and also show how intimately our bodies are linked to the world around us.

The June 28, 2000, issue of JAMA looked at 434,877 patients who presented to 1,674 American hospitals with heart attacks. 33% did not have chest pain on presentation to the hospital. This group contained more women (49% vs. 38%) and was on average 7 years older. Half of these patients were not diagnosed initially as having a heart attack. They were less likely to receive immediate treatment with clot busters or angioplasty (25% vs. 74%). Patients without chest pain had a 23.3% in-hospitality mortality rate vs. 9.3% for those with chest pain. This means they were 2.21 times more likely to die while in the hospital.

This study revealed that one in three patients with heart attacks does not have chest pain. A test such as coronary calcium scoring can determine the presence and severity of coronary plaque, and make it less likely that a heart attack will go undiagnosed.

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