Cholesterol counts in elderly, too

``Whether you are old or young, cholesterol counts -- you can improve your quality of life by caring about your cholesterol,'' said study co-author Dr. James Cleeman.

Heart disease most often strikes at age 65 or older, according to a panel of experts from the National Cholesterol Education Program (NCEP). But even though a high level of LDL -- the so-called ``bad'' cholesterol -- is known to increase the risk of heart disease, some research has suggested that high cholesterol may not be as dangerous in the elderly, the investigators note.

However, based on a review of a number of studies, the team concludes that age alone should not rule out elderly people from being considered for cholesterol-lowering therapy.

For a long time, older patients were not believed to benefit from efforts to keep cholesterol under control, the report's lead author, Dr. Scott M. Grundy, of the University of Texas Southwestern Medical Center at Dallas, told Reuters Health in an interview. ``But the idea that cholesterol doesn't count in the elderly has been refuted,'' he said.

Elderly people who have heart disease or who are otherwise at high risk for heart attack or stroke and have high cholesterol are prime candidates for medications that can lower cholesterol levels, the researchers note. Grundy and his colleagues point out that recent studies have shown that cholesterol-lowering drugs known as statins are equally effective in young and old alike.

However, except for those at high risk, the elderly should first concentrate on improving their diet, becoming more physically active and losing weight, they state.

Even though some experts have questioned the need for cholesterol testing among the elderly, Grundy and his colleagues write that it should be performed every 5 years as in other adults.

The NCEP report does distinguish between elderly who are generally healthy and those who have serious health problems, such as cancer, dementia and chronic lung disease. While healthy elderly who have a good life-expectancy should have their cholesterol monitored, those who have a limited life-expectancy ``are poor candidates for cholesterol-lowering therapy,'' the study authors write.

Grundy and colleagues also conclude that postmenopausal women who have high cholesterol should not rely on hormone replacement for protection against heart attack and stroke. The NCEP team cites one study that found combination therapy with estrogen and progestin did not reduce heart attacks and heart-related deaths in a group of women with heart disease.

SOURCE: Archives of Internal Medicine 1999;159:1670-1678.

Experts identify new form of appendicitis

Hypersensitivity to specific neural compounds ``might cause abdominal pain'' in about 15% to 25% of appendicitis cases, according to European researchers led by Dr. Markus Buchler of the University of Berne, Switzerland. Their findings are published in the August 7th issue of The Lancet.

About 6% of individuals will experience appendicitis during their lifetimes. The illness is characterized by acute abdominal pain, usually triggered by inflammation of the small intestinal appendage.

Nevertheless, a minority of appendectomies result in the removal of normal-sized, apparently healthy specimens. Because ''every surgeon would like to avoid unnecessary appendectomies,'' Buchler's team focused on identifying the cause of pain in these cases.

To do so, they compared tissues from 16 inflamed appendices to tissues from 15 normal-looking specimens.

According to the investigators, 'normal' organs differed from inflamed organs in one important respect -- an increased density of nerve fibers reactive to two immune-system neuropeptides, SP and VIP.

SP and VIP are both strongly associated with the production of pain linked to inflammation. Buchler and colleagues believe that increased nervous sensitivity to either of these compounds could trigger the pain associated with appendicitis -- without the usual inflammation.

These findings were supported by the fact that 13 of the 15 patient with 'normal' appendices ``were symptom-free after operation, even though their appendix appeared normal at (laboratory) examination.''

Based on these findings, the authors believe that 'neuroimmune appendicitis' should now be listed as a unique disorder, apart from inflammatory appendicitis.

SOURCE: The Lancet 1999;354:461-466.

Fish oil may cut death risk after heart attack

The n-3 polyunsaturated fatty acids (PUFAs) found in fish and fish oil ``significantly decreased ...the rate of death, non-fatal (heart attack) and stroke'' of over 11,000 Italian heart patients, report investigators led by Dr. Roberto Marchioli of Santa Maria Imbaro, Italy. Their findings are published in the August 7th issue of The Lancet.

Numerous studies have suggested that the consumption of fish and fish oil supplements can improve cardiovascular health. In their study, the authors examined the long-term effect of fish oil or vitamin E supplementation on the health of 11,324 Italian heart patients recovering from heart attack. Patients received either 1 gram/day of fish oil, 300 milligrams vitamin E, both supplements, or none for 3.5 years.

According to the researchers, daily fish oil supplementation was associated with an overall 10% reduced risk for death, fatal or nonfatal heart attack or stroke compared with patients who did not receive the supplements. ``Vitamin E had no benefit'' on cardiovascular health, according to the authors.

Most of the research conducted to date suggests that PUFAs protect cardiovascular health by preventing the onset of arrhythmias -- uncontrolled and sometimes dangerous irregular heart rhythms.

Previous trials have reported that vitamin E may help reduce risks for cardiac events after heart attack. Marchioli and his colleagues suggest that large randomized trials will be necessary to confirm the exact health benefits of this compound.

SOURCE: The Lancet 1999;354:447-455.

A chocolate a day might keep the doctor away

In a new study, chocolate was found to have four times the level of catechins, a type of antioxidant, compared with black tea. Some studies have suggested that tea-drinkers have a lower risk of cardiovascular disease and possibly cancer -- though the link is not conclusive. However, if the protective health effect is due to the catechins in tea, the health benefit may extend to chocolate as well, according to Dr. Ilja C.W. Arts, of the National Institute of Public Health and Environment, Bilthoven, the Netherlands, and colleagues.

In the study, the Dutch researchers analyzed the amount of six different catechins and found that dark chocolate contained the highest level, at 53.5 milligrams of catechins per 100 grams. Milk chocolate contained 15.9 milligrams per 100 grams, and black tea contained 13.9 milligrams per 100 milliliters, according to a report in the August 7th issue of The Lancet.

``Since it is probably more enjoyable to drink 1 liter of tea than to eat 1 kilogram of chocolate, we aimed to find out the importance of chocolate as a source of catechins in the habitual diet,'' the authors write.

They found that tea was the most important source of the antioxidants, making up 55% of total intake of the antioxidants by Dutch citizens. However, chocolate was an important source too, making up 20% of the total intake in this population.

The findings have important implications for studies of the health effects of tea, the investigators note, which should take into account other sources of catechins, such as chocolate.

``In the end,'' the researchers conclude, ``the old Dutch habit of drinking a cup of tea and eating a chocolate cookie might be not only enjoyable but healthy as well.''

SOURCE: The Lancet 1999;354:488.

Heat takes toll on football players

A disturbance of the body's heat-regulating mechanism, heatstroke is marked by extremely high body temperatures and can lead to convulsions and coma.

Heat-related deaths are largely preventable by shorter practices, regular cooling-off periods, avoiding high-intensity practice during the mid-afternoon when the sun is strongest and free-flowing water for all players, explain researchers from the University of North Carolina at Chapel Hill (UNC-CH). The new data is part of a yearly football death and injury survey.

``In the past 4 years, we have seen 11 football-related heatstroke deaths,'' reports Dr. Frederick Mueller, professor and chair of physical education, exercise and sports science at UNC-CH, in a written statement.

``Shorter practices in hot weather and non-contact drills during which players don't wear helmets can help prevent heatstroke and reduce accidents. Players should be allowed as much water as they want and coaches should schedule regular cooling-off breaks,'' he suggests.

``With many schools starting earlier this year and the very hot weather we have been having across the country, heatstroke could be an even bigger problem than in the past,'' Mueller says. ``Players should start off easy for at least 7 to 10 days to get them acclimated to the heat.''

In 1970, eight players died of heatstroke, making it the highest one-year total in the history of the survey. There were no heatstroke deaths in 1993 and 1994, study data show.

During 1998, seven football players died across the United States as a result of injuries sustained in the field, the study showed. Seven other players also died in fatalities unrelated to the game.

To stave off heat-related deaths and injuries, Mueller suggests that players salt food because salt helps retain water, and thus can help prevent dehydration. Players should weigh in before and after practice, if they lose more than 3% of there weight from one day to the next, they should not be allowed to practice because it suggests dehydration, he adds, noting that overweight athletes and those that try the hardest are at greatest risk of heatstroke.

``When you practice or play out in the heat, the most important thing is to be well-hydrated with water or a fluid replacement drink,'' Dr. Lewis G. Maharam, president of the New York chapter of the American College of Sports Medicine and a sports medicine specialist in New York, said in an interview with Reuters Health. The salt and sugar contained in fluid replacement drinks help the body to retain and use water, he explains.

``Coaches should weigh athletes before and after training and for every pound that they lose, they should drink 8 ounces of water or a fluid replacement drink,'' he suggests.

``If your urine is clear it means you have had enough fluid, if not, drink more,'' he says. ``Thirst is not a good mechanism to go by,'' Maharam adds.

``Overall, it's important to get your bodies used to being out in the hot weather, and try to do high-intensity workouts early in the morning,'' Maharam says, noting that the sun is strongest in the middle of the afternoon.

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