News in brief - Feb. 21, 2005

Stroke survivors who stop aspirin are at risk for another stroke, study says - Rheumatoid arthritis may increase risk of heart disease, heart attacks - Women prefer annual Pap smears despite guidelines, study reports - Viruses make first appearance on government-issued carcinogens list

Stroke survivors who stop aspirin are at risk for another stroke, study says

Stroke survivors who stopped taking their prescribed daily aspirin tripled their risk of having another stroke within the month, according to research presented Feb. 2 at the American Stroke Assn.'s International Stroke Conference 2005.

The results confirm previous observations in stroke survivors who quit taking aspirin, researchers said.

"This is the first controlled retrospective study to investigate the potential risk of suffering ischemic stroke shortly after discontinuing aspirin," said Patrik Michel, MD, co-author of the study and director of the acute stroke unit at Lausanne University in Lausanne, Switzerland.

The researchers selected 309 patients who had a stroke or transient ischemic attack and were on long-term aspirin therapy for secondary prevention of heart attack and stroke. They matched these patients with 309 control patients who had a stroke or TIA more than six months before and were using long-term aspirin therapy.

The average age of the entire study population was 71 years, and 62% were men. In each group, about 69% had hypertension, 20% had diabetes and 14% were smokers.

Rheumatoid arthritis may increase risk of heart disease, heart attacks

People with rheumatoid arthritis not only have a higher risk of coronary heart disease than those in the general population, but they also have more silent, unrecognized heart attacks and sudden cardiac deaths, according to a Mayo Clinic study published in the February issue of Arthritis & Rheumatism. They are much less likely to complain of chest pain.

Increased heart disease risk may be present even before noticing rheumatoid arthritis, researchers said.

The researchers were surprised that the increase in cardiac events could not be explained by an increase in traditional heart disease risk factors such as elevated cholesterol, blood pressure and body mass index, diabetes and alcohol abuse, said Hilal Maradit Kremers, MD, lead investigator and a research associate in Mayo's Dept. of Health Sciences Research.

When the rheumatoid arthritis patient saw a physician for other reasons and an electrocardiogram was ordered, it revealed past silent attacks.

"We suspect that the systemic inflammation that characterizes rheumatoid arthritis also promotes cardiovascular disease and cardiovascular death," said Sherine Gabriel, MD, the study's senior author and Mayo Clinic rheumatologist, epidemiologist and chair of the Dept. of Health Sciences Research.

The goal of our research is to disentangle the complex relationship between these two diseases," Dr. Gabriel said.

Women prefer annual Pap smears despite guidelines, study reports

Many women prefer to have a Pap smear every year and believe that recommendations for reduced frequency are based on efforts to reduce health care costs rather than scientific evidence indicating that this is the more effective strategy, according to a study published in this month's American Journal of Medicine.

Researchers surveyed 360 women over age 40 without a history of cancer and found that 63% preferred to be screened annually and 12% wanted it done every six months. Also, 69% would continue to attempt to receive more frequent screening even if their physician recommended less.

"The response is clear," wrote George F. Sawaya, MD, associate professor in obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, in an accompanying editorial. "Women do not want less than annual screening, regardless of guidelines."

Most guidelines currently recommend that women over age 30 with at least three prior normal smears reduce screening to every two or three years.

Viruses make first appearance on government-issued carcinogens list

Hepatitis B and C, along with human papillomaviruses, have become the first viruses officially listed as cancer causes in a Dept. of Health and Human Services' bi-annual report.

The 11th edition of the Report on Carcinogens issued last month featured 17 new substances, bringing the list of cancer causing agents to a new high of 246.

"Among U.S. residents, one in two men and one in three women will develop cancer at some point in their lifetimes," said Kenneth Olden, PhD, director of the National Institute of Environmental Health Sciences and the National Toxicology Program. "Research shows that environmental factors trigger diseases like cancer, especially when someone has a family history."

New additions to the list also include several lead and lead compounds, x-rays and an assortment of compounds used in textile dyes.